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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2 Enrolled Bill (ENR)]

        H.R.2

                     One Hundred Fourteenth Congress

                                 of the

                        United States of America

                          AT THE FIRST SESSION

          Begun and held at the City of Washington on Tuesday,
           the sixth day of January, two thousand and fifteen

                                 An Act

 
 To amend title XVIII of the Social Security Act to repeal the Medicare 
  sustainable growth rate and strengthen Medicare access by improving 
  physician payments and making other improvements, to reauthorize the 
      Children's Health Insurance Program, and for other purposes.

    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 Access 
and CHIP Reauthorization Act of 2015''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

     TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION

Sec. 101. Repealing the sustainable growth rate (SGR) and improving 
          Medicare payment for physicians' services.
Sec. 102. Priorities and funding for measure development.
Sec. 103. Encouraging care management for individuals with chronic care 
          needs.
Sec. 104. Empowering beneficiary choices through continued access to 
          information on physicians' services.
Sec. 105. Expanding availability of Medicare data.
Sec. 106. Reducing administrative burden and other provisions.

              TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

                     Subtitle A--Medicare Extenders

Sec. 201. Extension of work GPCI floor.
Sec. 202. Extension of therapy cap exceptions process.
Sec. 203. Extension of ambulance add-ons.
Sec. 204. Extension of increased inpatient hospital payment adjustment 
          for certain low-volume hospitals.
Sec. 205. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 206. Extension for specialized Medicare Advantage plans for special 
          needs individuals.
Sec. 207. Extension of funding for quality measure endorsement, input, 
          and selection.
Sec. 208. Extension of funding outreach and assistance for low-income 
          programs.
Sec. 209. Extension and transition of reasonable cost reimbursement 
          contracts.
Sec. 210. Extension of home health rural add-on.

                   Subtitle B--Other Health Extenders

Sec. 211. Permanent extension of the qualifying individual (QI) program.
Sec. 212. Permanent extension of transitional medical assistance (TMA).
Sec. 213. Extension of special diabetes program for type I diabetes and 
          for Indians.
Sec. 214. Extension of abstinence education.
Sec. 215. Extension of personal responsibility education program (PREP).
Sec. 216. Extension of funding for family-to-family health information 
          centers.
Sec. 217. Extension of health workforce demonstration project for low-
          income individuals.
Sec. 218. Extension of maternal, infant, and early childhood home 
          visiting programs.
Sec. 219. Tennessee DSH allotment for fiscal years 2015 through 2025.
Sec. 220. Delay in effective date for Medicaid amendments relating to 
          beneficiary liability settlements.
Sec. 221. Extension of funding for community health centers, the 
          National Health Service Corps, and teaching health centers.

                             TITLE III--CHIP

Sec. 301. 2-year extension of the Children's Health Insurance Program.
Sec. 302. Extension of express lane eligibility.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension of certain programs and demonstration projects.
Sec. 305. Report of Inspector General of HHS on use of express lane 
          option under Medicaid and CHIP.

                            TITLE IV--OFFSETS

                Subtitle A--Medicare Beneficiary Reforms

Sec. 401. Limitation on certain medigap policies for newly eligible 
          Medicare beneficiaries.
Sec. 402. Income-related premium adjustment for parts B and D.

                        Subtitle B--Other Offsets

Sec. 411. Medicare payment updates for post-acute providers.
Sec. 412. Delay of reduction to Medicaid DSH allotments.
Sec. 413. Levy on delinquent providers.
Sec. 414. Adjustments to inpatient hospital payment rates.

                         TITLE V--MISCELLANEOUS

            Subtitle A--Protecting the Integrity of Medicare

Sec. 501. Prohibition of inclusion of Social Security account numbers on 
          Medicare cards.
Sec. 502. Preventing wrongful Medicare payments for items and services 
          furnished to incarcerated individuals, individuals not 
          lawfully present, and deceased individuals.
Sec. 503. Consideration of measures regarding Medicare beneficiary smart 
          cards.
Sec. 504. Modifying Medicare durable medical equipment face-to-face 
          encounter documentation requirement.
Sec. 505. Reducing improper Medicare payments.
Sec. 506. Improving senior Medicare patrol and fraud reporting rewards.
Sec. 507. Requiring valid prescriber National Provider Identifiers on 
          pharmacy claims.
Sec. 508. Option to receive Medicare Summary Notice electronically.
Sec. 509. Renewal of MAC contracts.
Sec. 510. Study on pathway for incentives to States for State 
          participation in medicaid data match program.
Sec. 511. Guidance on application of Common Rule to clinical data 
          registries.
Sec. 512. Eliminating certain civil money penalties; gainsharing study 
          and report.
Sec. 513. Modification of Medicare home health surety bond condition of 
          participation requirement.
Sec. 514. Oversight of Medicare coverage of manual manipulation of the 
          spine to correct subluxation.
Sec. 515. National expansion of prior authorization model for repetitive 
          scheduled non-emergent ambulance transport.
Sec. 516. Repealing duplicative Medicare secondary payor provision.
Sec. 517. Plan for expanding data in annual CERT report.
Sec. 518. Removing funds for Medicare Improvement Fund added by IMPACT 
          Act of 2014.
Sec. 519. Rule of construction.

                      Subtitle B--Other Provisions

Sec. 521. Extension of two-midnight PAMA rules on certain medical review 
          activities.
Sec. 522. Requiring bid surety bonds and State licensure for entities 
          submitting bids under the Medicare DMEPOS competitive 
          acquisition program.
Sec. 523. Payment for global surgical packages.
Sec. 524. Extension of Secure Rural Schools and Community Self-
          Determination Act of 2000.
Sec. 525. Exclusion from PAYGO scorecards.

    TITLE I--SGR REPEAL AND MEDICARE PROVIDER PAYMENT MODERNIZATION

    SEC. 101. REPEALING THE SUSTAINABLE GROWTH RATE (SGR) AND IMPROVING 
      MEDICARE PAYMENT FOR PHYSICIANS' SERVICES.
    (a) Stabilizing Fee Updates.--
        (1) Repeal of sgr payment methodology.--Section 1848 of the 
    Social Security Act (42 U.S.C. 1395w-4) is amended--
            (A) in subsection (d)--
                (i) in paragraph (1)(A)--

                    (I) by inserting ``and ending with 2025'' after 
                ``beginning with 2001''; and
                    (II) by inserting ``or a subsequent paragraph'' 
                after ``paragraph (4)''; and

                (ii) in paragraph (4)--

                    (I) in the heading, by inserting ``and ending with 
                2014'' after ``years beginning with 2001''; and
                    (II) in subparagraph (A), by inserting ``and ending 
                with 2014'' after ``a year beginning with 2001''; and

            (B) in subsection (f)--
                (i) in paragraph (1)(B), by inserting ``through 2014'' 
            after ``of each succeeding year''; and
                (ii) in paragraph (2), in the matter preceding 
            subparagraph (A), by inserting ``and ending with 2014'' 
            after ``beginning with 2000''.
        (2) Update of rates for 2015 and subsequent years.--Subsection 
    (d) of section 1848 of the Social Security Act (42 U.S.C. 1395w-4) 
    is amended--
            (A) in paragraph (1)(A), by adding at the end the 
        following: ``There shall be two separate conversion factors for 
        each year beginning with 2026, one for items and services 
        furnished by a qualifying APM participant (as defined in 
        section 1833(z)(2)) (referred to in this subsection as the 
        `qualifying APM conversion factor') and the other for other 
        items and services (referred to in this subsection as the 
        `nonqualifying APM conversion factor'), equal to the respective 
        conversion factor for the previous year (or, in the case of 
        2026, equal to the single conversion factor for 2025) 
        multiplied by the update established under paragraph (20) for 
        such respective conversion factor for such year.'';
            (B) in paragraph (1)(D), by inserting ``(or, beginning with 
        2026, applicable conversion factor)'' after ``single conversion 
        factor''; and
            (C) by striking paragraph (16) and inserting the following 
        new paragraphs:
        ``(16) Update for january through june of 2015.--Subject to 
    paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), 
    (13)(B), (14)(B), and (15)(B), in lieu of the update to the single 
    conversion factor established in paragraph (1)(C) that would 
    otherwise apply for 2015 for the period beginning on January 1, 
    2015, and ending on June 30, 2015, the update to the single 
    conversion factor shall be 0.0 percent.
        ``(17) Update for july through december of 2015.--The update to 
    the single conversion factor established in paragraph (1)(C) for 
    the period beginning on July 1, 2015, and ending on December 31, 
    2015, shall be 0.5 percent.
        ``(18) Update for 2016 through 2019.--The update to the single 
    conversion factor established in paragraph (1)(C) for 2016 and each 
    subsequent year through 2019 shall be 0.5 percent.
        ``(19) Update for 2020 through 2025.--The update to the single 
    conversion factor established in paragraph (1)(C) for 2020 and each 
    subsequent year through 2025 shall be 0.0 percent.
        ``(20) Update for 2026 and subsequent years.--For 2026 and each 
    subsequent year, the update to the qualifying APM conversion factor 
    established under paragraph (1)(A) is 0.75 percent, and the update 
    to the nonqualifying APM conversion factor established under such 
    paragraph is 0.25 percent.''.
        (3) MedPAC reports.--
            (A) Initial report.--Not later than July 1, 2017, the 
        Medicare Payment Advisory Commission shall submit to Congress a 
        report on the relationship between--
                (i) physician and other health professional utilization 
            and expenditures (and the rate of increase of such 
            utilization and expenditures) of items and services for 
            which payment is made under section 1848 of the Social 
            Security Act (42 U.S.C. 1395w-4); and
                (ii) total utilization and expenditures (and the rate 
            of increase of such utilization and expenditures) under 
            parts A, B, and D of title XVIII of such Act.
        Such report shall include a methodology to describe such 
        relationship and the impact of changes in such physician and 
        other health professional practice and service ordering 
        patterns on total utilization and expenditures under parts A, 
        B, and D of such title.
            (B) Final report.--Not later than July 1, 2021, the 
        Medicare Payment Advisory Commission shall submit to Congress a 
        report on the relationship described in subparagraph (A), 
        including the results determined from applying the methodology 
        included in the report submitted under such subparagraph.
            (C) Report on update to physicians' services under 
        medicare.--Not later than July 1, 2019, the Medicare Payment 
        Advisory Commission shall submit to Congress a report on--
                (i) the payment update for professional services 
            applied under the Medicare program under title XVIII of the 
            Social Security Act for the period of years 2015 through 
            2019;
                (ii) the effect of such update on the efficiency, 
            economy, and quality of care provided under such program;
                (iii) the effect of such update on ensuring a 
            sufficient number of providers to maintain access to care 
            by Medicare beneficiaries; and
                (iv) recommendations for any future payment updates for 
            professional services under such program to ensure adequate 
            access to care is maintained for Medicare beneficiaries.
    (b) Consolidation of Certain Current Law Performance Programs With 
New Merit-Based Incentive Payment System.--
        (1) EHR meaningful use incentive program.--
            (A) Sunsetting separate meaningful use payment 
        adjustments.--Section 1848(a)(7)(A) of the Social Security Act 
        (42 U.S.C. 1395w-4(a)(7)(A)) is amended--
                (i) in clause (i), by striking ``2015 or any subsequent 
            payment year'' and inserting ``each of 2015 through 2018'';
                (ii) in clause (ii)(III), by striking ``each subsequent 
            year'' and inserting ``2018''; and
                (iii) in clause (iii)--

                    (I) in the heading, by striking ``and subsequent 
                years'';
                    (II) by striking ``and each subsequent year''; and
                    (III) by striking ``, but in no case shall the 
                applicable percent be less than 95 percent''.

            (B) Continuation of meaningful use determinations for 
        mips.--Section 1848(o)(2) of the Social Security Act (42 U.S.C. 
        1395w-4(o)(2)) is amended--
                (i) in subparagraph (A), in the matter preceding clause 
            (i)--

                    (I) by striking ``For purposes of paragraph (1), 
                an'' and inserting ``An''; and
                    (II) by inserting ``, or pursuant to subparagraph 
                (D) for purposes of subsection (q), for a performance 
                period under such subsection for a year'' after ``under 
                such subsection for a year''; and

                (ii) by adding at the end the following new 
            subparagraph:
            ``(D) Continued application for purposes of mips.--With 
        respect to 2019 and each subsequent payment year, the Secretary 
        shall, for purposes of subsection (q) and in accordance with 
        paragraph (1)(F) of such subsection, determine whether an 
        eligible professional who is a MIPS eligible professional (as 
        defined in subsection (q)(1)(C)) for such year is a meaningful 
        EHR user under this paragraph for the performance period under 
        subsection (q) for such year.''.
        (2) Quality reporting.--
            (A) Sunsetting separate quality reporting incentives.--
        Section 1848(a)(8)(A) of the Social Security Act (42 U.S.C. 
        1395w-4(a)(8)(A)) is amended--
                (i) in clause (i), by striking ``2015 or any subsequent 
            year'' and inserting ``each of 2015 through 2018''; and
                (ii) in clause (ii)(II), by striking ``and each 
            subsequent year'' and inserting ``, 2017, and 2018''.
            (B) Continuation of quality measures and processes for 
        mips.--Section 1848 of the Social Security Act (42 U.S.C. 
        1395w-4) is amended--
                (i) in subsection (k), by adding at the end the 
            following new paragraph:
        ``(9) Continued application for purposes of mips and for 
    certain professionals volunteering to report.--The Secretary shall, 
    in accordance with subsection (q)(1)(F), carry out the provisions 
    of this subsection--
            ``(A) for purposes of subsection (q); and
            ``(B) for eligible professionals who are not MIPS eligible 
        professionals (as defined in subsection (q)(1)(C)) for the year 
        involved.''; and
                (ii) in subsection (m)--

                    (I) by redesignating paragraph (7) added by section 
                10327(a) of Public Law 111-148 as paragraph (8); and
                    (II) by adding at the end the following new 
                paragraph:

        ``(9) Continued application for purposes of mips and for 
    certain professionals volunteering to report.--The Secretary shall, 
    in accordance with subsection (q)(1)(F), carry out the processes 
    under this subsection--
            ``(A) for purposes of subsection (q); and
            ``(B) for eligible professionals who are not MIPS eligible 
        professionals (as defined in subsection (q)(1)(C)) for the year 
        involved.''.
        (3) Value-based payments.--
            (A) Sunsetting separate value-based payments.--Clause (iii) 
        of section 1848(p)(4)(B) of the Social Security Act (42 U.S.C. 
        1395w-4(p)(4)(B)) is amended to read as follows:
                ``(iii) Application.--The Secretary shall apply the 
            payment modifier established under this subsection for 
            items and services furnished on or after January 1, 2015, 
            with respect to specific physicians and groups of 
            physicians the Secretary determines appropriate, and for 
            services furnished on or after January 1, 2017, with 
            respect to all physicians and groups of physicians. Such 
            payment modifier shall not be applied for items and 
            services furnished on or after January 1, 2019.''.
            (B) Continuation of value-based payment modifier measures 
        for mips.--Section 1848(p) of the Social Security Act (42 
        U.S.C. 1395w-4(p)) is amended--
                (i) in paragraph (2), by adding at the end the 
            following new subparagraph:
            ``(C) Continued application for purposes of mips.--The 
        Secretary shall, in accordance with subsection (q)(1)(F), carry 
        out subparagraph (B) for purposes of subsection (q).''; and
                (ii) in paragraph (3), by adding at the end the 
            following: ``With respect to 2019 and each subsequent year, 
            the Secretary shall, in accordance with subsection 
            (q)(1)(F), carry out this paragraph for purposes of 
            subsection (q).''.
    (c) Merit-Based Incentive Payment System.--
        (1) In general.--Section 1848 of the Social Security Act (42 
    U.S.C. 1395w-4) is amended by adding at the end the following new 
    subsection:
    ``(q) Merit-Based Incentive Payment System.--
        ``(1) Establishment.--
            ``(A) In general.--Subject to the succeeding provisions of 
        this subsection, the Secretary shall establish an eligible 
        professional Merit-based Incentive Payment System (in this 
        subsection referred to as the `MIPS') under which the Secretary 
        shall--
                ``(i) develop a methodology for assessing the total 
            performance of each MIPS eligible professional according to 
            performance standards under paragraph (3) for a performance 
            period (as established under paragraph (4)) for a year;
                ``(ii) using such methodology, provide for a composite 
            performance score in accordance with paragraph (5) for each 
            such professional for each performance period; and
                ``(iii) use such composite performance score of the 
            MIPS eligible professional for a performance period for a 
            year to determine and apply a MIPS adjustment factor (and, 
            as applicable, an additional MIPS adjustment factor) under 
            paragraph (6) to the professional for the year.
        Notwithstanding subparagraph (C)(ii), under the MIPS, the 
        Secretary shall permit any eligible professional (as defined in 
        subsection (k)(3)(B)) to report on applicable measures and 
        activities described in paragraph (2)(B).
            ``(B) Program implementation.--The MIPS shall apply to 
        payments for items and services furnished on or after January 
        1, 2019.
            ``(C) MIPS eligible professional defined.--
                ``(i) In general.--For purposes of this subsection, 
            subject to clauses (ii) and (iv), the term `MIPS eligible 
            professional' means--

                    ``(I) for the first and second years for which the 
                MIPS applies to payments (and for the performance 
                period for such first and second year), a physician (as 
                defined in section 1861(r)), a physician assistant, 
                nurse practitioner, and clinical nurse specialist (as 
                such terms are defined in section 1861(aa)(5)), a 
                certified registered nurse anesthetist (as defined in 
                section 1861(bb)(2)), and a group that includes such 
                professionals; and
                    ``(II) for the third year for which the MIPS 
                applies to payments (and for the performance period for 
                such third year) and for each succeeding year (and for 
                the performance period for each such year), the 
                professionals described in subclause (I), such other 
                eligible professionals (as defined in subsection 
                (k)(3)(B)) as specified by the Secretary, and a group 
                that includes such professionals.

                ``(ii) Exclusions.--For purposes of clause (i), the 
            term `MIPS eligible professional' does not include, with 
            respect to a year, an eligible professional (as defined in 
            subsection (k)(3)(B)) who--

                    ``(I) is a qualifying APM participant (as defined 
                in section 1833(z)(2));
                    ``(II) subject to clause (vii), is a partial 
                qualifying APM participant (as defined in clause (iii)) 
                for the most recent period for which data are available 
                and who, for the performance period with respect to 
                such year, does not report on applicable measures and 
                activities described in paragraph (2)(B) that are 
                required to be reported by such a professional under 
                the MIPS; or
                    ``(III) for the performance period with respect to 
                such year, does not exceed the low-volume threshold 
                measurement selected under clause (iv).

                ``(iii) Partial qualifying apm participant.--For 
            purposes of this subparagraph, the term `partial qualifying 
            APM participant' means, with respect to a year, an eligible 
            professional for whom the Secretary determines the minimum 
            payment percentage (or percentages), as applicable, 
            described in paragraph (2) of section 1833(z) for such year 
            have not been satisfied, but who would be considered a 
            qualifying APM participant (as defined in such paragraph) 
            for such year if--

                    ``(I) with respect to 2019 and 2020, the reference 
                in subparagraph (A) of such paragraph to 25 percent was 
                instead a reference to 20 percent;
                    ``(II) with respect to 2021 and 2022--

                        ``(aa) the reference in subparagraph (B)(i) of 
                    such paragraph to 50 percent was instead a 
                    reference to 40 percent; and
                        ``(bb) the references in subparagraph (B)(ii) 
                    of such paragraph to 50 percent and 25 percent of 
                    such paragraph were instead references to 40 
                    percent and 20 percent, respectively; and

                    ``(III) with respect to 2023 and subsequent years--

                        ``(aa) the reference in subparagraph (C)(i) of 
                    such paragraph to 75 percent was instead a 
                    reference to 50 percent; and
                        ``(bb) the references in subparagraph (C)(ii) 
                    of such paragraph to 75 percent and 25 percent of 
                    such paragraph were instead references to 50 
                    percent and 20 percent, respectively.
                ``(iv) Selection of low-volume threshold measurement.--
            The Secretary shall select a low-volume threshold to apply 
            for purposes of clause (ii)(III), which may include one or 
            more or a combination of the following:

                    ``(I) The minimum number (as determined by the 
                Secretary) of individuals enrolled under this part who 
                are treated by the eligible professional for the 
                performance period involved.
                    ``(II) The minimum number (as determined by the 
                Secretary) of items and services furnished to 
                individuals enrolled under this part by such 
                professional for such performance period.
                    ``(III) The minimum amount (as determined by the 
                Secretary) of allowed charges billed by such 
                professional under this part for such performance 
                period.

                ``(v) Treatment of new medicare enrolled eligible 
            professionals.--In the case of a professional who first 
            becomes a Medicare enrolled eligible professional during 
            the performance period for a year (and had not previously 
            submitted claims under this title such as a person, an 
            entity, or a part of a physician group or under a different 
            billing number or tax identifier), such professional shall 
            not be treated under this subsection as a MIPS eligible 
            professional until the subsequent year and performance 
            period for such subsequent year.
                ``(vi) Clarification.--In the case of items and 
            services furnished during a year by an individual who is 
            not a MIPS eligible professional (including pursuant to 
            clauses (ii) and (v)) with respect to a year, in no case 
            shall a MIPS adjustment factor (or additional MIPS 
            adjustment factor) under paragraph (6) apply to such 
            individual for such year.
                ``(vii) Partial qualifying apm participant 
            clarifications.--

                    ``(I) Treatment as mips eligible professional.--In 
                the case of an eligible professional who is a partial 
                qualifying APM participant, with respect to a year, and 
                who, for the performance period for such year, reports 
                on applicable measures and activities described in 
                paragraph (2)(B) that are required to be reported by 
                such a professional under the MIPS, such eligible 
                professional is considered to be a MIPS eligible 
                professional with respect to such year.
                    ``(II) Not eligible for qualifying apm participant 
                payments.--In no case shall an eligible professional 
                who is a partial qualifying APM participant, with 
                respect to a year, be considered a qualifying APM 
                participant (as defined in paragraph (2) of section 
                1833(z)) for such year or be eligible for the 
                additional payment under paragraph (1) of such section 
                for such year.

            ``(D) Application to group practices.--
                ``(i) In general.--Under the MIPS:

                    ``(I) Quality performance category.--The Secretary 
                shall establish and apply a process that includes 
                features of the provisions of subsection (m)(3)(C) for 
                MIPS eligible professionals in a group practice with 
                respect to assessing performance of such group with 
                respect to the performance category described in clause 
                (i) of paragraph (2)(A).
                    ``(II) Other performance categories.--The Secretary 
                may establish and apply a process that includes 
                features of the provisions of subsection (m)(3)(C) for 
                MIPS eligible professionals in a group practice with 
                respect to assessing the performance of such group with 
                respect to the performance categories described in 
                clauses (ii) through (iv) of such paragraph.

                ``(ii) Ensuring comprehensiveness of group practice 
            assessment.--The process established under clause (i) shall 
            to the extent practicable reflect the range of items and 
            services furnished by the MIPS eligible professionals in 
            the group practice involved.
            ``(E) Use of registries.--Under the MIPS, the Secretary 
        shall encourage the use of qualified clinical data registries 
        pursuant to subsection (m)(3)(E) in carrying out this 
        subsection.
            ``(F) Application of certain provisions.--In applying a 
        provision of subsection (k), (m), (o), or (p) for purposes of 
        this subsection, the Secretary shall--
                ``(i) adjust the application of such provision to 
            ensure the provision is consistent with the provisions of 
            this subsection; and
                ``(ii) not apply such provision to the extent that the 
            provision is duplicative with a provision of this 
            subsection.
            ``(G) Accounting for risk factors.--
                ``(i) Risk factors.--Taking into account the relevant 
            studies conducted and recommendations made in reports under 
            section 2(d) of the Improving Medicare Post-Acute Care 
            Transformation Act of 2014, and, as appropriate, other 
            information, including information collected before 
            completion of such studies and recommendations, the 
            Secretary, on an ongoing basis, shall, as the Secretary 
            determines appropriate and based on an individual's health 
            status and other risk factors--

                    ``(I) assess appropriate adjustments to quality 
                measures, resource use measures, and other measures 
                used under the MIPS; and
                    ``(II) assess and implement appropriate adjustments 
                to payment adjustments, composite performance scores, 
                scores for performance categories, or scores for 
                measures or activities under the MIPS.

        ``(2) Measures and activities under performance categories.--
            ``(A) Performance categories.--Under the MIPS, the 
        Secretary shall use the following performance categories (each 
        of which is referred to in this subsection as a performance 
        category) in determining the composite performance score under 
        paragraph (5):
                ``(i) Quality.
                ``(ii) Resource use.
                ``(iii) Clinical practice improvement activities.
                ``(iv) Meaningful use of certified EHR technology.
            ``(B) Measures and activities specified for each 
        category.--For purposes of paragraph (3)(A) and subject to 
        subparagraph (C), measures and activities specified for a 
        performance period (as established under paragraph (4)) for a 
        year are as follows:
                ``(i) Quality.--For the performance category described 
            in subparagraph (A)(i), the quality measures included in 
            the final measures list published under subparagraph (D)(i) 
            for such year and the list of quality measures described in 
            subparagraph (D)(vi) used by qualified clinical data 
            registries under subsection (m)(3)(E).
                ``(ii) Resource use.--For the performance category 
            described in subparagraph (A)(ii), the measurement of 
            resource use for such period under subsection (p)(3), using 
            the methodology under subsection (r) as appropriate, and, 
            as feasible and applicable, accounting for the cost of 
            drugs under part D.
                ``(iii) Clinical practice improvement activities.--For 
            the performance category described in subparagraph 
            (A)(iii), clinical practice improvement activities (as 
            defined in subparagraph (C)(v)(III)) under subcategories 
            specified by the Secretary for such period, which shall 
            include at least the following:

                    ``(I) The subcategory of expanded practice access, 
                such as same day appointments for urgent needs and 
                after hours access to clinician advice.
                    ``(II) The subcategory of population management, 
                such as monitoring health conditions of individuals to 
                provide timely health care interventions or 
                participation in a qualified clinical data registry.
                    ``(III) The subcategory of care coordination, such 
                as timely communication of test results, timely 
                exchange of clinical information to patients and other 
                providers, and use of remote monitoring or telehealth.
                    ``(IV) The subcategory of beneficiary engagement, 
                such as the establishment of care plans for individuals 
                with complex care needs, beneficiary self-management 
                assessment and training, and using shared decision-
                making mechanisms.
                    ``(V) The subcategory of patient safety and 
                practice assessment, such as through use of clinical or 
                surgical checklists and practice assessments related to 
                maintaining certification.
                    ``(VI) The subcategory of participation in an 
                alternative payment model (as defined in section 
                1833(z)(3)(C)).

            In establishing activities under this clause, the Secretary 
            shall give consideration to the circumstances of small 
            practices (consisting of 15 or fewer professionals) and 
            practices located in rural areas and in health professional 
            shortage areas (as designated under section 332(a)(1)(A) of 
            the Public Health Service Act).
                ``(iv) Meaningful ehr use.--For the performance 
            category described in subparagraph (A)(iv), the 
            requirements established for such period under subsection 
            (o)(2) for determining whether an eligible professional is 
            a meaningful EHR user.
            ``(C) Additional provisions.--
                ``(i) Emphasizing outcome measures under the quality 
            performance category.--In applying subparagraph (B)(i), the 
            Secretary shall, as feasible, emphasize the application of 
            outcome measures.
                ``(ii) Application of additional system measures.--The 
            Secretary may use measures used for a payment system other 
            than for physicians, such as measures for inpatient 
            hospitals, for purposes of the performance categories 
            described in clauses (i) and (ii) of subparagraph (A). For 
            purposes of the previous sentence, the Secretary may not 
            use measures for hospital outpatient departments, except in 
            the case of items and services furnished by emergency 
            physicians, radiologists, and anesthesiologists.
                ``(iii) Global and population-based measures.--The 
            Secretary may use global measures, such as global outcome 
            measures, and population-based measures for purposes of the 
            performance category described in subparagraph (A)(i).
                ``(iv) Application of measures and activities to non-
            patient-facing professionals.--In carrying out this 
            paragraph, with respect to measures and activities 
            specified in subparagraph (B) for performance categories 
            described in subparagraph (A), the Secretary--

                    ``(I) shall give consideration to the circumstances 
                of professional types (or subcategories of those types 
                determined by practice characteristics) who typically 
                furnish services that do not involve face-to-face 
                interaction with a patient; and
                    ``(II) may, to the extent feasible and appropriate, 
                take into account such circumstances and apply under 
                this subsection with respect to MIPS eligible 
                professionals of such professional types or 
                subcategories, alternative measures or activities that 
                fulfill the goals of the applicable performance 
                category.

            In carrying out the previous sentence, the Secretary shall 
            consult with professionals of such professional types or 
            subcategories.
                ``(v) Clinical practice improvement activities.--

                    ``(I) Request for information.--In initially 
                applying subparagraph (B)(iii), the Secretary shall use 
                a request for information to solicit recommendations 
                from stakeholders to identify activities described in 
                such subparagraph and specifying criteria for such 
                activities.
                    ``(II) Contract authority for clinical practice 
                improvement activities performance category.--In 
                applying subparagraph (B)(iii), the Secretary may 
                contract with entities to assist the Secretary in--

                        ``(aa) identifying activities described in 
                    subparagraph (B)(iii);
                        ``(bb) specifying criteria for such activities; 
                    and
                        ``(cc) determining whether a MIPS eligible 
                    professional meets such criteria.

                    ``(III) Clinical practice improvement activities 
                defined.--For purposes of this subsection, the term 
                `clinical practice improvement activity' means an 
                activity that relevant eligible professional 
                organizations and other relevant stakeholders identify 
                as improving clinical practice or care delivery and 
                that the Secretary determines, when effectively 
                executed, is likely to result in improved outcomes.

            ``(D) Annual list of quality measures available for mips 
        assessment.--
                ``(i) In general.--Under the MIPS, the Secretary, 
            through notice and comment rulemaking and subject to the 
            succeeding clauses of this subparagraph, shall, with 
            respect to the performance period for a year, establish an 
            annual final list of quality measures from which MIPS 
            eligible professionals may choose for purposes of 
            assessment under this subsection for such performance 
            period. Pursuant to the previous sentence, the Secretary 
            shall--

                    ``(I) not later than November 1 of the year prior 
                to the first day of the first performance period under 
                the MIPS, establish and publish in the Federal Register 
                a final list of quality measures; and
                    ``(II) not later than November 1 of the year prior 
                to the first day of each subsequent performance period, 
                update the final list of quality measures from the 
                previous year (and publish such updated final list in 
                the Federal Register), by--

                        ``(aa) removing from such list, as appropriate, 
                    quality measures, which may include the removal of 
                    measures that are no longer meaningful (such as 
                    measures that are topped out);
                        ``(bb) adding to such list, as appropriate, new 
                    quality measures; and
                        ``(cc) determining whether or not quality 
                    measures on such list that have undergone 
                    substantive changes should be included in the 
                    updated list.
                ``(ii) Call for quality measures.--

                    ``(I) In general.--Eligible professional 
                organizations and other relevant stakeholders shall be 
                requested to identify and submit quality measures to be 
                considered for selection under this subparagraph in the 
                annual list of quality measures published under clause 
                (i) and to identify and submit updates to the measures 
                on such list. For purposes of the previous sentence, 
                measures may be submitted regardless of whether such 
                measures were previously published in a proposed rule 
                or endorsed by an entity with a contract under section 
                1890(a).
                    ``(II) Eligible professional organization 
                defined.--In this subparagraph, the term `eligible 
                professional organization' means a professional 
                organization as defined by nationally recognized 
                specialty boards of certification or equivalent 
                certification boards.

                ``(iii) Requirements.--In selecting quality measures 
            for inclusion in the annual final list under clause (i), 
            the Secretary shall--

                    ``(I) provide that, to the extent practicable, all 
                quality domains (as defined in subsection (s)(1)(B)) 
                are addressed by such measures; and
                    ``(II) ensure that such selection is consistent 
                with the process for selection of measures under 
                subsections (k), (m), and (p)(2).

                ``(iv) Peer review.--Before including a new measure in 
            the final list of measures published under clause (i) for a 
            year, the Secretary shall submit for publication in 
            applicable specialty-appropriate, peer-reviewed journals 
            such measure and the method for developing and selecting 
            such measure, including clinical and other data supporting 
            such measure.
                ``(v) Measures for inclusion.--The final list of 
            quality measures published under clause (i) shall include, 
            as applicable, measures under subsections (k), (m), and 
            (p)(2), including quality measures from among--

                    ``(I) measures endorsed by a consensus-based 
                entity;
                    ``(II) measures developed under subsection (s); and
                    ``(III) measures submitted under clause (ii)(I).

            Any measure selected for inclusion in such list that is not 
            endorsed by a consensus-based entity shall have a focus 
            that is evidence-based.
                ``(vi) Exception for qualified clinical data registry 
            measures.--Measures used by a qualified clinical data 
            registry under subsection (m)(3)(E) shall not be subject to 
            the requirements under clauses (i), (iv), and (v). The 
            Secretary shall publish the list of measures used by such 
            qualified clinical data registries on the Internet website 
            of the Centers for Medicare & Medicaid Services.
                ``(vii) Exception for existing quality measures.--Any 
            quality measure specified by the Secretary under subsection 
            (k) or (m), including under subsection (m)(3)(E), and any 
            measure of quality of care established under subsection 
            (p)(2) for the reporting period or performance period under 
            the respective subsection beginning before the first 
            performance period under the MIPS--

                    ``(I) shall not be subject to the requirements 
                under clause (i) (except under items (aa) and (cc) of 
                subclause (II) of such clause) or to the requirement 
                under clause (iv); and
                    ``(II) shall be included in the final list of 
                quality measures published under clause (i) unless 
                removed under clause (i)(II)(aa).

                ``(viii) Consultation with relevant eligible 
            professional organizations and other relevant 
            stakeholders.--Relevant eligible professional organizations 
            and other relevant stakeholders, including State and 
            national medical societies, shall be consulted in carrying 
            out this subparagraph.
                ``(ix) Optional application.--The process under section 
            1890A is not required to apply to the selection of measures 
            under this subparagraph.
        ``(3) Performance standards.--
            ``(A) Establishment.--Under the MIPS, the Secretary shall 
        establish performance standards with respect to measures and 
        activities specified under paragraph (2)(B) for a performance 
        period (as established under paragraph (4)) for a year.
            ``(B) Considerations in establishing standards.--In 
        establishing such performance standards with respect to 
        measures and activities specified under paragraph (2)(B), the 
        Secretary shall consider the following:
                ``(i) Historical performance standards.
                ``(ii) Improvement.
                ``(iii) The opportunity for continued improvement.
        ``(4) Performance period.--The Secretary shall establish a 
    performance period (or periods) for a year (beginning with 2019). 
    Such performance period (or periods) shall begin and end prior to 
    the beginning of such year and be as close as possible to such 
    year. In this subsection, such performance period (or periods) for 
    a year shall be referred to as the performance period for the year.
        ``(5) Composite performance score.--
            ``(A) In general.--Subject to the succeeding provisions of 
        this paragraph and taking into account, as available and 
        applicable, paragraph (1)(G), the Secretary shall develop a 
        methodology for assessing the total performance of each MIPS 
        eligible professional according to performance standards under 
        paragraph (3) with respect to applicable measures and 
        activities specified in paragraph (2)(B) with respect to each 
        performance category applicable to such professional for a 
        performance period (as established under paragraph (4)) for a 
        year. Using such methodology, the Secretary shall provide for a 
        composite assessment (using a scoring scale of 0 to 100) for 
        each such professional for the performance period for such 
        year. In this subsection such a composite assessment for such a 
        professional with respect to a performance period shall be 
        referred to as the `composite performance score' for such 
        professional for such performance period.
            ``(B) Incentive to report; encouraging use of certified ehr 
        technology for reporting quality measures.--
                ``(i) Incentive to report.--Under the methodology 
            established under subparagraph (A), the Secretary shall 
            provide that in the case of a MIPS eligible professional 
            who fails to report on an applicable measure or activity 
            that is required to be reported by the professional, the 
            professional shall be treated as achieving the lowest 
            potential score applicable to such measure or activity.
                ``(ii) Encouraging use of certified ehr technology and 
            qualified clinical data registries for reporting quality 
            measures.--Under the methodology established under 
            subparagraph (A), the Secretary shall--

                    ``(I) encourage MIPS eligible professionals to 
                report on applicable measures with respect to the 
                performance category described in paragraph (2)(A)(i) 
                through the use of certified EHR technology and 
                qualified clinical data registries; and
                    ``(II) with respect to a performance period, with 
                respect to a year, for which a MIPS eligible 
                professional reports such measures through the use of 
                such EHR technology, treat such professional as 
                satisfying the clinical quality measures reporting 
                requirement described in subsection (o)(2)(A)(iii) for 
                such year.

            ``(C) Clinical practice improvement activities performance 
        score.--
                ``(i) Rule for certification.--A MIPS eligible 
            professional who is in a practice that is certified as a 
            patient-centered medical home or comparable specialty 
            practice, as determined by the Secretary, with respect to a 
            performance period shall be given the highest potential 
            score for the performance category described in paragraph 
            (2)(A)(iii) for such period.
                ``(ii) APM participation.--Participation by a MIPS 
            eligible professional in an alternative payment model (as 
            defined in section 1833(z)(3)(C)) with respect to a 
            performance period shall earn such eligible professional a 
            minimum score of one-half of the highest potential score 
            for the performance category described in paragraph 
            (2)(A)(iii) for such performance period.
                ``(iii) Subcategories.--A MIPS eligible professional 
            shall not be required to perform activities in each 
            subcategory under paragraph (2)(B)(iii) or participate in 
            an alternative payment model in order to achieve the 
            highest potential score for the performance category 
            described in paragraph (2)(A)(iii).
            ``(D) Achievement and improvement.--
                ``(i) Taking into account improvement.--Beginning with 
            the second year to which the MIPS applies, in addition to 
            the achievement of a MIPS eligible professional, if data 
            sufficient to measure improvement is available, the 
            methodology developed under subparagraph (A)--

                    ``(I) in the case of the performance score for the 
                performance category described in clauses (i) and (ii) 
                of paragraph (2)(A), shall take into account the 
                improvement of the professional; and
                    ``(II) in the case of performance scores for other 
                performance categories, may take into account the 
                improvement of the professional.

                ``(ii) Assigning higher weight for achievement.--
            Subject to clause (i), under the methodology developed 
            under subparagraph (A), the Secretary may assign a higher 
            scoring weight under subparagraph (F) with respect to the 
            achievement of a MIPS eligible professional than with 
            respect to any improvement of such professional applied 
            under clause (i) with respect to a measure, activity, or 
            category described in paragraph (2).
            ``(E) Weights for the performance categories.--
                ``(i) In general.--Under the methodology developed 
            under subparagraph (A), subject to subparagraph (F)(i) and 
            clause (ii), the composite performance score shall be 
            determined as follows:

                    ``(I) Quality.--

                        ``(aa) In general.--Subject to item (bb), 
                    thirty percent of such score shall be based on 
                    performance with respect to the category described 
                    in clause (i) of paragraph (2)(A). In applying the 
                    previous sentence, the Secretary shall, as 
                    feasible, encourage the application of outcome 
                    measures within such category.
                        ``(bb) First 2 years.--For the first and second 
                    years for which the MIPS applies to payments, the 
                    percentage applicable under item (aa) shall be 
                    increased in a manner such that the total 
                    percentage points of the increase under this item 
                    for the respective year equals the total number of 
                    percentage points by which the percentage applied 
                    under subclause (II)(bb) for the respective year is 
                    less than 30 percent.

                    ``(II) Resource use.--

                        ``(aa) In general.--Subject to item (bb), 
                    thirty percent of such score shall be based on 
                    performance with respect to the category described 
                    in clause (ii) of paragraph (2)(A).
                        ``(bb) First 2 years.--For the first year for 
                    which the MIPS applies to payments, not more than 
                    10 percent of such score shall be based on 
                    performance with respect to the category described 
                    in clause (ii) of paragraph (2)(A). For the second 
                    year for which the MIPS applies to payments, not 
                    more than 15 percent of such score shall be based 
                    on performance with respect to the category 
                    described in clause (ii) of paragraph (2)(A).

                    ``(III) Clinical practice improvement activities.--
                Fifteen percent of such score shall be based on 
                performance with respect to the category described in 
                clause (iii) of paragraph (2)(A).
                    ``(IV) Meaningful use of certified ehr 
                technology.--Twenty-five percent of such score shall be 
                based on performance with respect to the category 
                described in clause (iv) of paragraph (2)(A).

                ``(ii) Authority to adjust percentages in case of high 
            ehr meaningful use adoption.--In any year in which the 
            Secretary estimates that the proportion of eligible 
            professionals (as defined in subsection (o)(5)) who are 
            meaningful EHR users (as determined under subsection 
            (o)(2)) is 75 percent or greater, the Secretary may reduce 
            the percent applicable under clause (i)(IV), but not below 
            15 percent. If the Secretary makes such reduction for a 
            year, subject to subclauses (I)(bb) and (II)(bb) of clause 
            (i), the percentages applicable under one or more of 
            subclauses (I), (II), and (III) of clause (i) for such year 
            shall be increased in a manner such that the total 
            percentage points of the increase under this clause for 
            such year equals the total number of percentage points 
            reduced under the preceding sentence for such year.
            ``(F) Certain flexibility for weighting performance 
        categories, measures, and activities.--Under the methodology 
        under subparagraph (A), if there are not sufficient measures 
        and activities (described in paragraph (2)(B)) applicable and 
        available to each type of eligible professional involved, the 
        Secretary shall assign different scoring weights (including a 
        weight of 0)--
                ``(i) which may vary from the scoring weights specified 
            in subparagraph (E), for each performance category based on 
            the extent to which the category is applicable to the type 
            of eligible professional involved; and
                ``(ii) for each measure and activity specified under 
            paragraph (2)(B) with respect to each such category based 
            on the extent to which the measure or activity is 
            applicable and available to the type of eligible 
            professional involved.
            ``(G) Resource use.--Analysis of the performance category 
        described in paragraph (2)(A)(ii) shall include results from 
        the methodology described in subsection (r)(5), as appropriate.
            ``(H) Inclusion of quality measure data from other 
        payers.--In applying subsections (k), (m), and (p) with respect 
        to measures described in paragraph (2)(B)(i), analysis of the 
        performance category described in paragraph (2)(A)(i) may 
        include data submitted by MIPS eligible professionals with 
        respect to items and services furnished to individuals who are 
        not individuals entitled to benefits under part A or enrolled 
        under part B.
            ``(I) Use of voluntary virtual groups for certain 
        assessment purposes.--
                ``(i) In general.--In the case of MIPS eligible 
            professionals electing to be a virtual group under clause 
            (ii) with respect to a performance period for a year, for 
            purposes of applying the methodology under subparagraph (A) 
            with respect to the performance categories described in 
            clauses (i) and (ii) of paragraph (2)(A)--

                    ``(I) the assessment of performance provided under 
                such methodology with respect to such performance 
                categories that is to be applied to each such 
                professional in such group for such performance period 
                shall be with respect to the combined performance of 
                all such professionals in such group for such period; 
                and
                    ``(II) with respect to the composite performance 
                score provided under this paragraph for such 
                performance period for each such MIPS eligible 
                professional in such virtual group, the components of 
                the composite performance score that assess performance 
                with respect to such performance categories shall be 
                based on the assessment of the combined performance 
                under subclause (I) for such performance categories and 
                performance period.

                ``(ii) Election of practices to be a virtual group.--
            The Secretary shall, in accordance with the requirements 
            under clause (iii), establish and have in place a process 
            to allow an individual MIPS eligible professional or a 
            group practice consisting of not more than 10 MIPS eligible 
            professionals to elect, with respect to a performance 
            period for a year to be a virtual group under this 
            subparagraph with at least one other such individual MIPS 
            eligible professional or group practice. Such a virtual 
            group may be based on appropriate classifications of 
            providers, such as by geographic areas or by provider 
            specialties defined by nationally recognized specialty 
            boards of certification or equivalent certification boards.
                ``(iii) Requirements.--The requirements for the process 
            under clause (ii) shall--

                    ``(I) provide that an election under such clause, 
                with respect to a performance period, shall be made 
                before the beginning of such performance period and may 
                not be changed during such performance period;
                    ``(II) provide that an individual MIPS eligible 
                professional and a group practice described in clause 
                (ii) may elect to be in no more than one virtual group 
                for a performance period and that, in the case of such 
                a group practice that elects to be in such virtual 
                group for such performance period, such election 
                applies to all MIPS eligible professionals in such 
                group practice;
                    ``(III) provide that a virtual group be a 
                combination of tax identification numbers;
                    ``(IV) provide for formal written agreements among 
                MIPS eligible professionals electing to be a virtual 
                group under this subparagraph; and
                    ``(V) include such other requirements as the 
                Secretary determines appropriate.

        ``(6) MIPS payments.--
            ``(A) MIPS adjustment factor.--Taking into account 
        paragraph (1)(G), the Secretary shall specify a MIPS adjustment 
        factor for each MIPS eligible professional for a year. Such 
        MIPS adjustment factor for a MIPS eligible professional for a 
        year shall be in the form of a percent and shall be 
        determined--
                ``(i) by comparing the composite performance score of 
            the eligible professional for such year to the performance 
            threshold established under subparagraph (D)(i) for such 
            year;
                ``(ii) in a manner such that the adjustment factors 
            specified under this subparagraph for a year result in 
            differential payments under this paragraph reflecting 
            that--

                    ``(I) MIPS eligible professionals with composite 
                performance scores for such year at or above such 
                performance threshold for such year receive zero or 
                positive payment adjustment factors for such year in 
                accordance with clause (iii), with such professionals 
                having higher composite performance scores receiving 
                higher adjustment factors; and
                    ``(II) MIPS eligible professionals with composite 
                performance scores for such year below such performance 
                threshold for such year receive negative payment 
                adjustment factors for such year in accordance with 
                clause (iv), with such professionals having lower 
                composite performance scores receiving lower adjustment 
                factors;

                ``(iii) in a manner such that MIPS eligible 
            professionals with composite scores described in clause 
            (ii)(I) for such year, subject to clauses (i) and (ii) of 
            subparagraph (F), receive a zero or positive adjustment 
            factor on a linear sliding scale such that an adjustment 
            factor of 0 percent is assigned for a score at the 
            performance threshold and an adjustment factor of the 
            applicable percent specified in subparagraph (B) is 
            assigned for a score of 100; and
                ``(iv) in a manner such that--

                    ``(I) subject to subclause (II), MIPS eligible 
                professionals with composite performance scores 
                described in clause (ii)(II) for such year receive a 
                negative payment adjustment factor on a linear sliding 
                scale such that an adjustment factor of 0 percent is 
                assigned for a score at the performance threshold and 
                an adjustment factor of the negative of the applicable 
                percent specified in subparagraph (B) is assigned for a 
                score of 0; and
                    ``(II) MIPS eligible professionals with composite 
                performance scores that are equal to or greater than 0, 
                but not greater than \1/4\ of the performance threshold 
                specified under subparagraph (D)(i) for such year, 
                receive a negative payment adjustment factor that is 
                equal to the negative of the applicable percent 
                specified in subparagraph (B) for such year.

            ``(B) Applicable percent defined.--For purposes of this 
        paragraph, the term `applicable percent' means--
                ``(i) for 2019, 4 percent;
                ``(ii) for 2020, 5 percent;
                ``(iii) for 2021, 7 percent; and
                ``(iv) for 2022 and subsequent years, 9 percent.
            ``(C) Additional mips adjustment factors for exceptional 
        performance.--For 2019 and each subsequent year through 2024, 
        in the case of a MIPS eligible professional with a composite 
        performance score for a year at or above the additional 
        performance threshold under subparagraph (D)(ii) for such year, 
        in addition to the MIPS adjustment factor under subparagraph 
        (A) for the eligible professional for such year, subject to 
        subparagraph (F)(iv), the Secretary shall specify an additional 
        positive MIPS adjustment factor for such professional and year. 
        Such additional MIPS adjustment factors shall be in the form of 
        a percent and determined by the Secretary in a manner such that 
        professionals having higher composite performance scores above 
        the additional performance threshold receive higher additional 
        MIPS adjustment factors.
            ``(D) Establishment of performance thresholds.--
                ``(i) Performance threshold.--For each year of the 
            MIPS, the Secretary shall compute a performance threshold 
            with respect to which the composite performance score of 
            MIPS eligible professionals shall be compared for purposes 
            of determining adjustment factors under subparagraph (A) 
            that are positive, negative, and zero. Such performance 
            threshold for a year shall be the mean or median (as 
            selected by the Secretary) of the composite performance 
            scores for all MIPS eligible professionals with respect to 
            a prior period specified by the Secretary. The Secretary 
            may reassess the selection of the mean or median under the 
            previous sentence every 3 years.
                ``(ii) Additional performance threshold for exceptional 
            performance.--In addition to the performance threshold 
            under clause (i), for each year of the MIPS, the Secretary 
            shall compute an additional performance threshold for 
            purposes of determining the additional MIPS adjustment 
            factors under subparagraph (C). For each such year, the 
            Secretary shall apply either of the following methods for 
            computing such additional performance threshold for such a 
            year:

                    ``(I) The threshold shall be the score that is 
                equal to the 25th percentile of the range of possible 
                composite performance scores above the performance 
                threshold determined under clause (i).
                    ``(II) The threshold shall be the score that is 
                equal to the 25th percentile of the actual composite 
                performance scores for MIPS eligible professionals with 
                composite performance scores at or above the 
                performance threshold with respect to the prior period 
                described in clause (i).

                ``(iii) Special rule for initial 2 years.--With respect 
            to each of the first two years to which the MIPS applies, 
            the Secretary shall, prior to the performance period for 
            such years, establish a performance threshold for purposes 
            of determining MIPS adjustment factors under subparagraph 
            (A) and a threshold for purposes of determining additional 
            MIPS adjustment factors under subparagraph (C). Each such 
            performance threshold shall--

                    ``(I) be based on a period prior to such 
                performance periods; and
                    ``(II) take into account--

                        ``(aa) data available with respect to 
                    performance on measures and activities that may be 
                    used under the performance categories under 
                    subparagraph (2)(B); and
                        ``(bb) other factors determined appropriate by 
                    the Secretary.
            ``(E) Application of mips adjustment factors.--In the case 
        of items and services furnished by a MIPS eligible professional 
        during a year (beginning with 2019), the amount otherwise paid 
        under this part with respect to such items and services and 
        MIPS eligible professional for such year, shall be multiplied 
        by--
                ``(i) 1, plus
                ``(ii) the sum of--

                    ``(I) the MIPS adjustment factor determined under 
                subparagraph (A) divided by 100, and
                    ``(II) as applicable, the additional MIPS 
                adjustment factor determined under subparagraph (C) 
                divided by 100.

            ``(F) Aggregate application of mips adjustment factors.--
                ``(i) Application of scaling factor.--

                    ``(I) In general.--With respect to positive MIPS 
                adjustment factors under subparagraph (A)(ii)(I) for 
                eligible professionals whose composite performance 
                score is above the performance threshold under 
                subparagraph (D)(i) for such year, subject to subclause 
                (II), the Secretary shall increase or decrease such 
                adjustment factors by a scaling factor in order to 
                ensure that the budget neutrality requirement of clause 
                (ii) is met.
                    ``(II) Scaling factor limit.--In no case may the 
                scaling factor applied under this clause exceed 3.0.

                ``(ii) Budget neutrality requirement.--

                    ``(I) In general.--Subject to clause (iii), the 
                Secretary shall ensure that the estimated amount 
                described in subclause (II) for a year is equal to the 
                estimated amount described in subclause (III) for such 
                year.
                    ``(II) Aggregate increases.--The amount described 
                in this subclause is the estimated increase in the 
                aggregate allowed charges resulting from the 
                application of positive MIPS adjustment factors under 
                subparagraph (A) (after application of the scaling 
                factor described in clause (i)) to MIPS eligible 
                professionals whose composite performance score for a 
                year is above the performance threshold under 
                subparagraph (D)(i) for such year.
                    ``(III) Aggregate decreases.--The amount described 
                in this subclause is the estimated decrease in the 
                aggregate allowed charges resulting from the 
                application of negative MIPS adjustment factors under 
                subparagraph (A) to MIPS eligible professionals whose 
                composite performance score for a year is below the 
                performance threshold under subparagraph (D)(i) for 
                such year.

                ``(iii) Exceptions.--

                    ``(I) In the case that all MIPS eligible 
                professionals receive composite performance scores for 
                a year that are below the performance threshold under 
                subparagraph (D)(i) for such year, the negative MIPS 
                adjustment factors under subparagraph (A) shall apply 
                with respect to such MIPS eligible professionals and 
                the budget neutrality requirement of clause (ii) and 
                the additional adjustment factors under clause (iv) 
                shall not apply for such year.
                    ``(II) In the case that, with respect to a year, 
                the application of clause (i) results in a scaling 
                factor equal to the maximum scaling factor specified in 
                clause (i)(II), such scaling factor shall apply and the 
                budget neutrality requirement of clause (ii) shall not 
                apply for such year.

                ``(iv) Additional incentive payment adjustments.--

                    ``(I) In general.--Subject to subclause (II), in 
                specifying the MIPS additional adjustment factors under 
                subparagraph (C) for each applicable MIPS eligible 
                professional for a year, the Secretary shall ensure 
                that the estimated aggregate increase in payments under 
                this part resulting from the application of such 
                additional adjustment factors for MIPS eligible 
                professionals in a year shall be equal (as estimated by 
                the Secretary) to $500,000,000 for each year beginning 
                with 2019 and ending with 2024.
                    ``(II) Limitation on additional incentive payment 
                adjustments.--The MIPS additional adjustment factor 
                under subparagraph (C) for a year for an applicable 
                MIPS eligible professional whose composite performance 
                score is above the additional performance threshold 
                under subparagraph (D)(ii) for such year shall not 
                exceed 10 percent. The application of the previous 
                sentence may result in an aggregate amount of 
                additional incentive payments that are less than the 
                amount specified in subclause (I).

        ``(7) Announcement of result of adjustments.--Under the MIPS, 
    the Secretary shall, not later than 30 days prior to January 1 of 
    the year involved, make available to MIPS eligible professionals 
    the MIPS adjustment factor (and, as applicable, the additional MIPS 
    adjustment factor) under paragraph (6) applicable to the eligible 
    professional for items and services furnished by the professional 
    for such year. The Secretary may include such information in the 
    confidential feedback under paragraph (12).
        ``(8) No effect in subsequent years.--The MIPS adjustment 
    factors and additional MIPS adjustment factors under paragraph (6) 
    shall apply only with respect to the year involved, and the 
    Secretary shall not take into account such adjustment factors in 
    making payments to a MIPS eligible professional under this part in 
    a subsequent year.
        ``(9) Public reporting.--
            ``(A) In general.--The Secretary shall, in an easily 
        understandable format, make available on the Physician Compare 
        Internet website of the Centers for Medicare & Medicaid 
        Services the following:
                ``(i) Information regarding the performance of MIPS 
            eligible professionals under the MIPS, which--

                    ``(I) shall include the composite score for each 
                such MIPS eligible professional and the performance of 
                each such MIPS eligible professional with respect to 
                each performance category; and
                    ``(II) may include the performance of each such 
                MIPS eligible professional with respect to each measure 
                or activity specified in paragraph (2)(B).

                ``(ii) The names of eligible professionals in eligible 
            alternative payment models (as defined in section 
            1833(z)(3)(D)) and, to the extent feasible, the names of 
            such eligible alternative payment models and performance of 
            such models.
            ``(B) Disclosure.--The information made available under 
        this paragraph shall indicate, where appropriate, that 
        publicized information may not be representative of the 
        eligible professional's entire patient population, the variety 
        of services furnished by the eligible professional, or the 
        health conditions of individuals treated.
            ``(C) Opportunity to review and submit corrections.--The 
        Secretary shall provide for an opportunity for a professional 
        described in subparagraph (A) to review, and submit corrections 
        for, the information to be made public with respect to the 
        professional under such subparagraph prior to such information 
        being made public.
            ``(D) Aggregate information.--The Secretary shall 
        periodically post on the Physician Compare Internet website 
        aggregate information on the MIPS, including the range of 
        composite scores for all MIPS eligible professionals and the 
        range of the performance of all MIPS eligible professionals 
        with respect to each performance category.
        ``(10) Consultation.--The Secretary shall consult with 
    stakeholders in carrying out the MIPS, including for the 
    identification of measures and activities under paragraph (2)(B) 
    and the methodologies developed under paragraphs (5)(A) and (6) and 
    regarding the use of qualified clinical data registries. Such 
    consultation shall include the use of a request for information or 
    other mechanisms determined appropriate.
        ``(11) Technical assistance to small practices and practices in 
    health professional shortage areas.--
            ``(A) In general.--The Secretary shall enter into contracts 
        or agreements with appropriate entities (such as quality 
        improvement organizations, regional extension centers (as 
        described in section 3012(c) of the Public Health Service Act), 
        or regional health collaboratives) to offer guidance and 
        assistance to MIPS eligible professionals in practices of 15 or 
        fewer professionals (with priority given to such practices 
        located in rural areas, health professional shortage areas (as 
        designated under in section 332(a)(1)(A) of such Act), and 
        medically underserved areas, and practices with low composite 
        scores) with respect to--
                ``(i) the performance categories described in clauses 
            (i) through (iv) of paragraph (2)(A); or
                ``(ii) how to transition to the implementation of and 
            participation in an alternative payment model as described 
            in section 1833(z)(3)(C).
            ``(B) Funding for technical assistance.--For purposes of 
        implementing subparagraph (A), the Secretary shall provide for 
        the transfer from the Federal Supplementary Medical Insurance 
        Trust Fund established under section 1841 to the Centers for 
        Medicare & Medicaid Services Program Management Account of 
        $20,000,000 for each of fiscal years 2016 through 2020. Amounts 
        transferred under this subparagraph for a fiscal year shall be 
        available until expended.
        ``(12) Feedback and information to improve performance.--
            ``(A) Performance feedback.--
                ``(i) In general.--Beginning July 1, 2017, the 
            Secretary--

                    ``(I) shall make available timely (such as 
                quarterly) confidential feedback to MIPS eligible 
                professionals on the performance of such professionals 
                with respect to the performance categories under 
                clauses (i) and (ii) of paragraph (2)(A); and
                    ``(II) may make available confidential feedback to 
                such professionals on the performance of such 
                professionals with respect to the performance 
                categories under clauses (iii) and (iv) of such 
                paragraph.

                ``(ii) Mechanisms.--The Secretary may use one or more 
            mechanisms to make feedback available under clause (i), 
            which may include use of a web-based portal or other 
            mechanisms determined appropriate by the Secretary. With 
            respect to the performance category described in paragraph 
            (2)(A)(i), feedback under this subparagraph shall, to the 
            extent an eligible professional chooses to participate in a 
            data registry for purposes of this subsection (including 
            registries under subsections (k) and (m)), be provided 
            based on performance on quality measures reported through 
            the use of such registries. With respect to any other 
            performance category described in paragraph (2)(A), the 
            Secretary shall encourage provision of feedback through 
            qualified clinical data registries as described in 
            subsection (m)(3)(E)).
                ``(iii) Use of data.--For purposes of clause (i), the 
            Secretary may use data, with respect to a MIPS eligible 
            professional, from periods prior to the current performance 
            period and may use rolling periods in order to make 
            illustrative calculations about the performance of such 
            professional.
                ``(iv) Disclosure exemption.--Feedback made available 
            under this subparagraph shall be exempt from disclosure 
            under section 552 of title 5, United States Code.
                ``(v) Receipt of information.--The Secretary may use 
            the mechanisms established under clause (ii) to receive 
            information from professionals, such as information with 
            respect to this subsection.
            ``(B) Additional information.--
                ``(i) In general.--Beginning July 1, 2018, the 
            Secretary shall make available to MIPS eligible 
            professionals information, with respect to individuals who 
            are patients of such MIPS eligible professionals, about 
            items and services for which payment is made under this 
            title that are furnished to such individuals by other 
            suppliers and providers of services, which may include 
            information described in clause (ii). Such information may 
            be made available under the previous sentence to such MIPS 
            eligible professionals by mechanisms determined appropriate 
            by the Secretary, which may include use of a web-based 
            portal. Such information may be made available in 
            accordance with the same or similar terms as data are made 
            available to accountable care organizations participating 
            in the shared savings program under section 1899.
                ``(ii) Type of information.--For purposes of clause 
            (i), the information described in this clause, is the 
            following:

                    ``(I) With respect to selected items and services 
                (as determined appropriate by the Secretary) for which 
                payment is made under this title and that are furnished 
                to individuals, who are patients of a MIPS eligible 
                professional, by another supplier or provider of 
                services during the most recent period for which data 
                are available (such as the most recent three-month 
                period), such as the name of such providers furnishing 
                such items and services to such patients during such 
                period, the types of such items and services so 
                furnished, and the dates such items and services were 
                so furnished.
                    ``(II) Historical data, such as averages and other 
                measures of the distribution if appropriate, of the 
                total, and components of, allowed charges (and other 
                figures as determined appropriate by the Secretary).

        ``(13) Review.--
            ``(A) Targeted review.--The Secretary shall establish a 
        process under which a MIPS eligible professional may seek an 
        informal review of the calculation of the MIPS adjustment 
        factor (or factors) applicable to such eligible professional 
        under this subsection for a year. The results of a review 
        conducted pursuant to the previous sentence shall not be taken 
        into account for purposes of paragraph (6) with respect to a 
        year (other than with respect to the calculation of such 
        eligible professional's MIPS adjustment factor for such year or 
        additional MIPS adjustment factor for such year) after the 
        factors determined in subparagraph (A) and subparagraph (C) of 
        such paragraph have been determined for such year.
            ``(B) Limitation.--Except as provided for in subparagraph 
        (A), there shall be no administrative or judicial review under 
        section 1869, section 1878, or otherwise of the following:
                ``(i) The methodology used to determine the amount of 
            the MIPS adjustment factor under paragraph (6)(A) and the 
            amount of the additional MIPS adjustment factor under 
            paragraph (6)(C) and the determination of such amounts.
                ``(ii) The establishment of the performance standards 
            under paragraph (3) and the performance period under 
            paragraph (4).
                ``(iii) The identification of measures and activities 
            specified under paragraph (2)(B) and information made 
            public or posted on the Physician Compare Internet website 
            of the Centers for Medicare & Medicaid Services under 
            paragraph (9).
                ``(iv) The methodology developed under paragraph (5) 
            that is used to calculate performance scores and the 
            calculation of such scores, including the weighting of 
            measures and activities under such methodology.''.
        (2) GAO reports.--
            (A) Evaluation of eligible professional mips.--Not later 
        than October 1, 2021, the Comptroller General of the United 
        States shall submit to Congress a report evaluating the 
        eligible professional Merit-based Incentive Payment System 
        under subsection (q) of section 1848 of the Social Security Act 
        (42 U.S.C. 1395w-4), as added by paragraph (1). Such report 
        shall--
                (i) examine the distribution of the composite 
            performance scores and MIPS adjustment factors (and 
            additional MIPS adjustment factors) for MIPS eligible 
            professionals (as defined in subsection (q)(1)(c) of such 
            section) under such program, and patterns relating to such 
            scores and adjustment factors, including based on type of 
            provider, practice size, geographic location, and patient 
            mix;
                (ii) provide recommendations for improving such 
            program;
                (iii) evaluate the impact of technical assistance 
            funding under section 1848(q)(11) of the Social Security 
            Act, as added by paragraph (1), on the ability of 
            professionals to improve within such program or 
            successfully transition to an alternative payment model (as 
            defined in section 1833(z)(3) of the Social Security Act, 
            as added by subsection (e)), with priority for such 
            evaluation given to practices located in rural areas, 
            health professional shortage areas (as designated in 
            section 332(a)(1)(A) of the Public Health Service Act), and 
            medically underserved areas; and
                (iv) provide recommendations for optimizing the use of 
            such technical assistance funds.
            (B) Study to examine alignment of quality measures used in 
        public and private programs.--
                (i) In general.--Not later than 18 months after the 
            date of the enactment of this Act, the Comptroller General 
            of the United States shall submit to Congress a report 
            that--

                    (I) compares the similarities and differences in 
                the use of quality measures under the original Medicare 
                fee-for-service program under parts A and B of title 
                XVIII of the Social Security Act, the Medicare 
                Advantage program under part C of such title, selected 
                State Medicaid programs under title XIX of such Act, 
                and private payer arrangements; and
                    (II) makes recommendations on how to reduce the 
                administrative burden involved in applying such quality 
                measures.

                (ii) Requirements.--The report under clause (i) shall--

                    (I) consider those measures applicable to 
                individuals entitled to, or enrolled for, benefits 
                under such part A, or enrolled under such part B and 
                individuals under the age of 65; and
                    (II) focus on those measures that comprise the most 
                significant component of the quality performance 
                category of the eligible professional MIPS incentive 
                program under subsection (q) of section 1848 of the 
                Social Security Act (42 U.S.C. 1395w-4), as added by 
                paragraph (1).

            (C) Study on role of independent risk managers.--Not later 
        than January 1, 2017, the Comptroller General of the United 
        States shall submit to Congress a report examining whether 
        entities that pool financial risk for physician practices, such 
        as independent risk managers, can play a role in supporting 
        physician practices, particularly small physician practices, in 
        assuming financial risk for the treatment of patients. Such 
        report shall examine barriers that small physician practices 
        currently face in assuming financial risk for treating 
        patients, the types of risk management entities that could 
        assist physician practices in participating in two-sided risk 
        payment models, and how such entities could assist with risk 
        management and with quality improvement activities. Such report 
        shall also include an analysis of any existing legal barriers 
        to such arrangements.
            (D) Study to examine rural and health professional shortage 
        area alternative payment models.--Not later than October 1, 
        2021, the Comptroller General of the United States shall submit 
        to Congress a report that examines the transition of 
        professionals in rural areas, health professional shortage 
        areas (as designated in section 332(a)(1)(A) of the Public 
        Health Service Act), or medically underserved areas to an 
        alternative payment model (as defined in section 1833(z)(3) of 
        the Social Security Act, as added by subsection (e)). Such 
        report shall make recommendations for removing administrative 
        barriers to practices, including small practices consisting of 
        15 or fewer professionals, in rural areas, health professional 
        shortage areas, and medically underserved areas to 
        participation in such models.
        (3) Funding for implementation.--For purposes of implementing 
    the provisions of and the amendments made by this section, the 
    Secretary of Health and Human Services shall provide for the 
    transfer of $80,000,000 from the Supplementary Medical Insurance 
    Trust Fund established under section 1841 of the Social Security 
    Act (42 U.S.C. 1395t) to the Centers for Medicare & Medicaid 
    Program Management Account for each of the fiscal years 2015 
    through 2019. Amounts transferred under this paragraph shall be 
    available until expended.
    (d) Improving Quality Reporting for Composite Scores.--
        (1) Changes for group reporting option.--
            (A) In general.--Section 1848(m)(3)(C)(ii) of the Social 
        Security Act (42 U.S.C. 1395w-4(m)(3)(C)(ii)) is amended by 
        inserting ``and, for 2016 and subsequent years, may provide'' 
        after ``shall provide''.
            (B) Clarification of qualified clinical data registry 
        reporting to group practices.--Section 1848(m)(3)(D) of the 
        Social Security Act (42 U.S.C. 1395w-4(m)(3)(D)) is amended by 
        inserting ``and, for 2016 and subsequent years, subparagraph 
        (A) or (C)'' after ``subparagraph (A)''.
        (2) Changes for multiple reporting periods and alternative 
    criteria for satisfactory reporting.--Section 1848(m)(5)(F) of the 
    Social Security Act (42 U.S.C. 1395w-4(m)(5)(F)) is amended--
            (A) by striking ``and subsequent years'' and inserting 
        ``through reporting periods occurring in 2015''; and
            (B) by inserting ``and, for reporting periods occurring in 
        2016 and subsequent years, the Secretary may establish'' after 
        ``shall establish''.
        (3) Physician feedback program reports succeeded by reports 
    under mips.--Section 1848(n) of the Social Security Act (42 U.S.C. 
    1395w-4(n)) is amended by adding at the end the following new 
    paragraph:
        ``(11) Reports ending with 2017.--Reports under the Program 
    shall not be provided after December 31, 2017. See subsection 
    (q)(12) for reports under the eligible professionals Merit-based 
    Incentive Payment System.''.
        (4) Coordination with satisfying meaningful ehr use clinical 
    quality measure reporting requirement.--Section 1848(o)(2)(A)(iii) 
    of the Social Security Act (42 U.S.C. 1395w-4(o)(2)(A)(iii)) is 
    amended by inserting ``and subsection (q)(5)(B)(ii)(II)'' after 
    ``Subject to subparagraph (B)(ii)''.
    (e) Promoting Alternative Payment Models.--
        (1) Increasing transparency of physician-focused payment 
    models.--Section 1868 of the Social Security Act (42 U.S.C. 1395ee) 
    is amended by adding at the end the following new subsection:
    ``(c) Physician-Focused Payment Models.--
        ``(1) Technical advisory committee.--
            ``(A) Establishment.--There is established an ad hoc 
        committee to be known as the `Physician-Focused Payment Model 
        Technical Advisory Committee' (referred to in this subsection 
        as the `Committee').
            ``(B) Membership.--
                ``(i) Number and appointment.--The Committee shall be 
            composed of 11 members appointed by the Comptroller General 
            of the United States.
                ``(ii) Qualifications.--The membership of the Committee 
            shall include individuals with national recognition for 
            their expertise in physician-focused payment models and 
            related delivery of care. No more than 5 members of the 
            Committee shall be providers of services or suppliers, or 
            representatives of providers of services or suppliers.
                ``(iii) Prohibition on federal employment.--A member of 
            the Committee shall not be an employee of the Federal 
            Government.
                ``(iv) Ethics disclosure.--The Comptroller General 
            shall establish a system for public disclosure by members 
            of the Committee of financial and other potential conflicts 
            of interest relating to such members. Members of the 
            Committee shall be treated as employees of Congress for 
            purposes of applying title I of the Ethics in Government 
            Act of 1978 (Public Law 95-521).
                ``(v) Date of initial appointments.--The initial 
            appointments of members of the Committee shall be made by 
            not later than 180 days after the date of enactment of this 
            subsection.
            ``(C) Term; vacancies.--
                ``(i) Term.--The terms of members of the Committee 
            shall be for 3 years except that the Comptroller General 
            shall designate staggered terms for the members first 
            appointed.
                ``(ii) Vacancies.--Any member appointed to fill a 
            vacancy occurring before the expiration of the term for 
            which the member's predecessor was appointed shall be 
            appointed only for the remainder of that term. A member may 
            serve after the expiration of that member's term until a 
            successor has taken office. A vacancy in the Committee 
            shall be filled in the manner in which the original 
            appointment was made.
            ``(D) Duties.--The Committee shall meet, as needed, to 
        provide comments and recommendations to the Secretary, as 
        described in paragraph (2)(C), on physician-focused payment 
        models.
            ``(E) Compensation of members.--
                ``(i) In general.--Except as provided in clause (ii), a 
            member of the Committee shall serve without compensation.
                ``(ii) Travel expenses.--A member of the Committee 
            shall be allowed travel expenses, including per diem in 
            lieu of subsistence, at rates authorized for an employee of 
            an agency under subchapter I of chapter 57 of title 5, 
            United States Code, while away from the home or regular 
            place of business of the member in the performance of the 
            duties of the Committee.
            ``(F) Operational and technical support.--
                ``(i) In general.--The Assistant Secretary for Planning 
            and Evaluation shall provide technical and operational 
            support for the Committee, which may be by use of a 
            contractor. The Office of the Actuary of the Centers for 
            Medicare & Medicaid Services shall provide to the Committee 
            actuarial assistance as needed.
                ``(ii) Funding.--The Secretary shall provide for the 
            transfer, from the Federal Supplementary Medical Insurance 
            Trust Fund under section 1841, such amounts as are 
            necessary to carry out this paragraph (not to exceed 
            $5,000,000) for fiscal year 2015 and each subsequent fiscal 
            year. Any amounts transferred under the preceding sentence 
            for a fiscal year shall remain available until expended.
            ``(G) Application.--Section 14 of the Federal Advisory 
        Committee Act (5 U.S.C. App.) shall not apply to the Committee.
        ``(2) Criteria and process for submission and review of 
    physician-focused payment models.--
            ``(A) Criteria for assessing physician-focused payment 
        models.--
                ``(i) Rulemaking.--Not later than November 1, 2016, the 
            Secretary shall, through notice and comment rulemaking, 
            following a request for information, establish criteria for 
            physician-focused payment models, including models for 
            specialist physicians, that could be used by the Committee 
            for making comments and recommendations pursuant to 
            paragraph (1)(D).
                ``(ii) MedPAC submission of comments.--During the 
            comment period for the proposed rule described in clause 
            (i), the Medicare Payment Advisory Commission may submit 
            comments to the Secretary on the proposed criteria under 
            such clause.
                ``(iii) Updating.--The Secretary may update the 
            criteria established under this subparagraph through 
            rulemaking.
            ``(B) Stakeholder submission of physician-focused payment 
        models.--On an ongoing basis, individuals and stakeholder 
        entities may submit to the Committee proposals for physician-
        focused payment models that such individuals and entities 
        believe meet the criteria described in subparagraph (A).
            ``(C) Committee review of models submitted.--The Committee 
        shall, on a periodic basis, review models submitted under 
        subparagraph (B), prepare comments and recommendations 
        regarding whether such models meet the criteria described in 
        subparagraph (A), and submit such comments and recommendations 
        to the Secretary.
            ``(D) Secretary review and response.--The Secretary shall 
        review the comments and recommendations submitted by the 
        Committee under subparagraph (C) and post a detailed response 
        to such comments and recommendations on the Internet website of 
        the Centers for Medicare & Medicaid Services.
        ``(3) Rule of construction.--Nothing in this subsection shall 
    be construed to impact the development or testing of models under 
    this title or titles XI, XIX, or XXI.''.
        (2) Incentive payments for participation in eligible 
    alternative payment models.--Section 1833 of the Social Security 
    Act (42 U.S.C. 1395l) is amended by adding at the end the following 
    new subsection:
    ``(z) Incentive Payments for Participation in Eligible Alternative 
Payment Models.--
        ``(1) Payment incentive.--
            ``(A) In general.--In the case of covered professional 
        services furnished by an eligible professional during a year 
        that is in the period beginning with 2019 and ending with 2024 
        and for which the professional is a qualifying APM participant 
        with respect to such year, in addition to the amount of payment 
        that would otherwise be made for such covered professional 
        services under this part for such year, there also shall be 
        paid to such professional an amount equal to 5 percent of the 
        estimated aggregate payment amounts for such covered 
        professional services under this part for the preceding year. 
        For purposes of the previous sentence, the payment amount for 
        the preceding year may be an estimation for the full preceding 
        year based on a period of such preceding year that is less than 
        the full year. The Secretary shall establish policies to 
        implement this subparagraph in cases in which payment for 
        covered professional services furnished by a qualifying APM 
        participant in an alternative payment model--
                ``(i) is made to an eligible alternative payment entity 
            rather than directly to the qualifying APM participant; or
                ``(ii) is made on a basis other than a fee-for-service 
            basis (such as payment on a capitated basis).
            ``(B) Form of payment.--Payments under this subsection 
        shall be made in a lump sum, on an annual basis, as soon as 
        practicable.
            ``(C) Treatment of payment incentive.--Payments under this 
        subsection shall not be taken into account for purposes of 
        determining actual expenditures under an alternative payment 
        model and for purposes of determining or rebasing any 
        benchmarks used under the alternative payment model.
            ``(D) Coordination.--The amount of the additional payment 
        under this subsection or subsection (m) shall be determined 
        without regard to any additional payment under subsection (m) 
        and this subsection, respectively. The amount of the additional 
        payment under this subsection or subsection (x) shall be 
        determined without regard to any additional payment under 
        subsection (x) and this subsection, respectively. The amount of 
        the additional payment under this subsection or subsection (y) 
        shall be determined without regard to any additional payment 
        under subsection (y) and this subsection, respectively.
        ``(2) Qualifying apm participant.--For purposes of this 
    subsection, the term `qualifying APM participant' means the 
    following:
            ``(A) 2019 and 2020.--With respect to 2019 and 2020, an 
        eligible professional for whom the Secretary determines that at 
        least 25 percent of payments under this part for covered 
        professional services furnished by such professional during the 
        most recent period for which data are available (which may be 
        less than a year) were attributable to such services furnished 
        under this part through an eligible alternative payment entity.
            ``(B) 2021 and 2022.--With respect to 2021 and 2022, an 
        eligible professional described in either of the following 
        clauses:
                ``(i) Medicare payment threshold option.--An eligible 
            professional for whom the Secretary determines that at 
            least 50 percent of payments under this part for covered 
            professional services furnished by such professional during 
            the most recent period for which data are available (which 
            may be less than a year) were attributable to such services 
            furnished under this part through an eligible alternative 
            payment entity.
                ``(ii) Combination all-payer and medicare payment 
            threshold option.--An eligible professional--

                    ``(I) for whom the Secretary determines, with 
                respect to items and services furnished by such 
                professional during the most recent period for which 
                data are available (which may be less than a year), 
                that at least 50 percent of the sum of--

                        ``(aa) payments described in clause (i); and
                        ``(bb) all other payments, regardless of payer 
                    (other than payments made by the Secretary of 
                    Defense or the Secretary of Veterans Affairs and 
                    other than payments made under title XIX in a State 
                    in which no medical home or alternative payment 
                    model is available under the State program under 
                    that title),

                meet the requirement described in clause (iii)(I) with 
                respect to payments described in item (aa) and meet the 
                requirement described in clause (iii)(II) with respect 
                to payments described in item (bb);
                    ``(II) for whom the Secretary determines at least 
                25 percent of payments under this part for covered 
                professional services furnished by such professional 
                during the most recent period for which data are 
                available (which may be less than a year) were 
                attributable to such services furnished under this part 
                through an eligible alternative payment entity; and
                    ``(III) who provides to the Secretary such 
                information as is necessary for the Secretary to make a 
                determination under subclause (I), with respect to such 
                professional.

                ``(iii) Requirement.--For purposes of clause (ii)(I)--

                    ``(I) the requirement described in this subclause, 
                with respect to payments described in item (aa) of such 
                clause, is that such payments are made to an eligible 
                alternative payment entity; and
                    ``(II) the requirement described in this subclause, 
                with respect to payments described in item (bb) of such 
                clause, is that such payments are made under 
                arrangements in which--

                        ``(aa) quality measures comparable to measures 
                    under the performance category described in section 
                    1848(q)(2)(B)(i) apply;
                        ``(bb) certified EHR technology is used; and
                        ``(cc) the eligible professional participates 
                    in an entity that--
                            ``(AA) bears more than nominal financial 
                        risk if actual aggregate expenditures exceeds 
                        expected aggregate expenditures; or
                            ``(BB) with respect to beneficiaries under 
                        title XIX, is a medical home that meets 
                        criteria comparable to medical homes expanded 
                        under section 1115A(c).
            ``(C) Beginning in 2023.--With respect to 2023 and each 
        subsequent year, an eligible professional described in either 
        of the following clauses:
                ``(i) Medicare payment threshold option.--An eligible 
            professional for whom the Secretary determines that at 
            least 75 percent of payments under this part for covered 
            professional services furnished by such professional during 
            the most recent period for which data are available (which 
            may be less than a year) were attributable to such services 
            furnished under this part through an eligible alternative 
            payment entity.
                ``(ii) Combination all-payer and medicare payment 
            threshold option.--An eligible professional--

                    ``(I) for whom the Secretary determines, with 
                respect to items and services furnished by such 
                professional during the most recent period for which 
                data are available (which may be less than a year), 
                that at least 75 percent of the sum of--

                        ``(aa) payments described in clause (i); and
                        ``(bb) all other payments, regardless of payer 
                    (other than payments made by the Secretary of 
                    Defense or the Secretary of Veterans Affairs and 
                    other than payments made under title XIX in a State 
                    in which no medical home or alternative payment 
                    model is available under the State program under 
                    that title),

                meet the requirement described in clause (iii)(I) with 
                respect to payments described in item (aa) and meet the 
                requirement described in clause (iii)(II) with respect 
                to payments described in item (bb);
                    ``(II) for whom the Secretary determines at least 
                25 percent of payments under this part for covered 
                professional services furnished by such professional 
                during the most recent period for which data are 
                available (which may be less than a year) were 
                attributable to such services furnished under this part 
                through an eligible alternative payment entity; and
                    ``(III) who provides to the Secretary such 
                information as is necessary for the Secretary to make a 
                determination under subclause (I), with respect to such 
                professional.

                ``(iii) Requirement.--For purposes of clause (ii)(I)--

                    ``(I) the requirement described in this subclause, 
                with respect to payments described in item (aa) of such 
                clause, is that such payments are made to an eligible 
                alternative payment entity; and
                    ``(II) the requirement described in this subclause, 
                with respect to payments described in item (bb) of such 
                clause, is that such payments are made under 
                arrangements in which--

                        ``(aa) quality measures comparable to measures 
                    under the performance category described in section 
                    1848(q)(2)(B)(i) apply;
                        ``(bb) certified EHR technology is used; and
                        ``(cc) the eligible professional participates 
                    in an entity that--
                            ``(AA) bears more than nominal financial 
                        risk if actual aggregate expenditures exceeds 
                        expected aggregate expenditures; or
                            ``(BB) with respect to beneficiaries under 
                        title XIX, is a medical home that meets 
                        criteria comparable to medical homes expanded 
                        under section 1115A(c).
            ``(D) Use of patient approach.--The Secretary may base the 
        determination of whether an eligible professional is a 
        qualifying APM participant under this subsection and the 
        determination of whether an eligible professional is a partial 
        qualifying APM participant under section 1848(q)(1)(C)(iii) by 
        using counts of patients in lieu of using payments and using 
        the same or similar percentage criteria (as specified in this 
        subsection and such section, respectively), as the Secretary 
        determines appropriate.
        ``(3) Additional definitions.--In this subsection:
            ``(A) Covered professional services.--The term `covered 
        professional services' has the meaning given that term in 
        section 1848(k)(3)(A).
            ``(B) Eligible professional.--The term `eligible 
        professional' has the meaning given that term in section 
        1848(k)(3)(B) and includes a group that includes such 
        professionals.
            ``(C) Alternative payment model (apm).--The term 
        `alternative payment model' means, other than for purposes of 
        subparagraphs (B)(ii)(I)(bb) and (C)(ii)(I)(bb) of paragraph 
        (2), any of the following:
                ``(i) A model under section 1115A (other than a health 
            care innovation award).
                ``(ii) The shared savings program under section 1899.
                ``(iii) A demonstration under section 1866C.
                ``(iv) A demonstration required by Federal law.
            ``(D) Eligible alternative payment entity.--The term 
        `eligible alternative payment entity' means, with respect to a 
        year, an entity that--
                ``(i) participates in an alternative payment model 
            that--

                    ``(I) requires participants in such model to use 
                certified EHR technology (as defined in subsection 
                (o)(4)); and
                    ``(II) provides for payment for covered 
                professional services based on quality measures 
                comparable to measures under the performance category 
                described in section 1848(q)(2)(B)(i); and

                ``(ii)(I) bears financial risk for monetary losses 
            under such alternative payment model that are in excess of 
            a nominal amount; or
                ``(II) is a medical home expanded under section 
            1115A(c).
        ``(4) Limitation.--There shall be no administrative or judicial 
    review under section 1869, 1878, or otherwise, of the following:
            ``(A) The determination that an eligible professional is a 
        qualifying APM participant under paragraph (2) and the 
        determination that an entity is an eligible alternative payment 
        entity under paragraph (3)(D).
            ``(B) The determination of the amount of the 5 percent 
        payment incentive under paragraph (1)(A), including any 
        estimation as part of such determination.''.
        (3) Coordination conforming amendments.--Section 1833 of the 
    Social Security Act (42 U.S.C. 1395l) is further amended--
            (A) in subsection (x)(3), by adding at the end the 
        following new sentence: ``The amount of the additional payment 
        for a service under this subsection and subsection (z) shall be 
        determined without regard to any additional payment for the 
        service under subsection (z) and this subsection, 
        respectively.''; and
            (B) in subsection (y)(3), by adding at the end the 
        following new sentence: ``The amount of the additional payment 
        for a service under this subsection and subsection (z) shall be 
        determined without regard to any additional payment for the 
        service under subsection (z) and this subsection, 
        respectively.''.
        (4) Encouraging development and testing of certain models.--
    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
    1315a(b)(2)) is amended--
            (A) in subparagraph (B), by adding at the end the following 
        new clauses:
                ``(xxi) Focusing primarily on physicians' services (as 
            defined in section 1848(j)(3)) furnished by physicians who 
            are not primary care practitioners.
                ``(xxii) Focusing on practices of 15 or fewer 
            professionals.
                ``(xxiii) Focusing on risk-based models for small 
            physician practices which may involve two-sided risk and 
            prospective patient assignment, and which examine risk-
            adjusted decreases in mortality rates, hospital 
            readmissions rates, and other relevant and appropriate 
            clinical measures.
                ``(xxiv) Focusing primarily on title XIX, working in 
            conjunction with the Center for Medicaid and CHIP 
            Services.''; and
            (B) in subparagraph (C)(viii), by striking ``other public 
        sector or private sector payers'' and inserting ``other public 
        sector payers, private sector payers, or statewide payment 
        models''.
        (5) Construction regarding telehealth services.--Nothing in the 
    provisions of, or amendments made by, this title shall be construed 
    as precluding an alternative payment model or a qualifying APM 
    participant (as those terms are defined in section 1833(z) of the 
    Social Security Act, as added by paragraph (1)) from furnishing a 
    telehealth service for which payment is not made under section 
    1834(m) of the Social Security Act (42 U.S.C. 1395m(m)).
        (6) Integrating medicare advantage alternative payment 
    models.--Not later than July 1, 2016, the Secretary of Health and 
    Human Services shall submit to Congress a study that examines the 
    feasibility of integrating alternative payment models in the 
    Medicare Advantage payment system. The study shall include the 
    feasibility of including a value-based modifier and whether such 
    modifier should be budget neutral.
        (7) Study and report on fraud related to alternative payment 
    models under the medicare program.--
            (A) Study.--The Secretary of Health and Human Services, in 
        consultation with the Inspector General of the Department of 
        Health and Human Services, shall conduct a study that--
                (i) examines the applicability of the Federal fraud 
            prevention laws to items and services furnished under title 
            XVIII of the Social Security Act for which payment is made 
            under an alternative payment model (as defined in section 
            1833(z)(3)(C) of such Act (42 U.S.C. 1395l(z)(3)(C)));
                (ii) identifies aspects of such alternative payment 
            models that are vulnerable to fraudulent activity; and
                (iii) examines the implications of waivers to such laws 
            granted in support of such alternative payment models, 
            including under any potential expansion of such models.
            (B) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report containing the results of the study conducted under 
        subparagraph (A). Such report shall include recommendations for 
        actions to be taken to reduce the vulnerability of such 
        alternative payment models to fraudulent activity. Such report 
        also shall include, as appropriate, recommendations of the 
        Inspector General for changes in Federal fraud prevention laws 
        to reduce such vulnerability.
    (f) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities To Improve Resource Use Measurement.--Section 
1848 of the Social Security Act (42 U.S.C. 1395w-4), as amended by 
subsection (c), is further amended by adding at the end the following 
new subsection:
    ``(r) Collaborating With the Physician, Practitioner, and Other 
Stakeholder Communities To Improve Resource Use Measurement.--
        ``(1) In general.--In order to involve the physician, 
    practitioner, and other stakeholder communities in enhancing the 
    infrastructure for resource use measurement, including for purposes 
    of the Merit-based Incentive Payment System under subsection (q) 
    and alternative payment models under section 1833(z), the Secretary 
    shall undertake the steps described in the succeeding provisions of 
    this subsection.
        ``(2) Development of care episode and patient condition groups 
    and classification codes.--
            ``(A) In general.--In order to classify similar patients 
        into care episode groups and patient condition groups, the 
        Secretary shall undertake the steps described in the succeeding 
        provisions of this paragraph.
            ``(B) Public availability of existing efforts to design an 
        episode grouper.--Not later than 180 days after the date of the 
        enactment of this subsection, the Secretary shall post on the 
        Internet website of the Centers for Medicare & Medicaid 
        Services a list of the episode groups developed pursuant to 
        subsection (n)(9)(A) and related descriptive information.
            ``(C) Stakeholder input.--The Secretary shall accept, 
        through the date that is 120 days after the day the Secretary 
        posts the list pursuant to subparagraph (B), suggestions from 
        physician specialty societies, applicable practitioner 
        organizations, and other stakeholders for episode groups in 
        addition to those posted pursuant to such subparagraph, and 
        specific clinical criteria and patient characteristics to 
        classify patients into--
                ``(i) care episode groups; and
                ``(ii) patient condition groups.
            ``(D) Development of proposed classification codes.--
                ``(i) In general.--Taking into account the information 
            described in subparagraph (B) and the information received 
            under subparagraph (C), the Secretary shall--

                    ``(I) establish care episode groups and patient 
                condition groups, which account for a target of an 
                estimated \1/2\ of expenditures under parts A and B 
                (with such target increasing over time as appropriate); 
                and
                    ``(II) assign codes to such groups.

                ``(ii) Care episode groups.--In establishing the care 
            episode groups under clause (i), the Secretary shall take 
            into account--

                    ``(I) the patient's clinical problems at the time 
                items and services are furnished during an episode of 
                care, such as the clinical conditions or diagnoses, 
                whether or not inpatient hospitalization occurs, and 
                the principal procedures or services furnished; and
                    ``(II) other factors determined appropriate by the 
                Secretary.

                ``(iii) Patient condition groups.--In establishing the 
            patient condition groups under clause (i), the Secretary 
            shall take into account--

                    ``(I) the patient's clinical history at the time of 
                a medical visit, such as the patient's combination of 
                chronic conditions, current health status, and recent 
                significant history (such as hospitalization and major 
                surgery during a previous period, such as 3 months); 
                and
                    ``(II) other factors determined appropriate by the 
                Secretary, such as eligibility status under this title 
                (including eligibility under section 226(a), 226(b), or 
                226A, and dual eligibility under this title and title 
                XIX).

            ``(E) Draft care episode and patient condition groups and 
        classification codes.--Not later than 270 days after the end of 
        the comment period described in subparagraph (C), the Secretary 
        shall post on the Internet website of the Centers for Medicare 
        & Medicaid Services a draft list of the care episode and 
        patient condition codes established under subparagraph (D) (and 
        the criteria and characteristics assigned to such code).
            ``(F) Solicitation of input.--The Secretary shall seek, 
        through the date that is 120 days after the Secretary posts the 
        list pursuant to subparagraph (E), comments from physician 
        specialty societies, applicable practitioner organizations, and 
        other stakeholders, including representatives of individuals 
        entitled to benefits under part A or enrolled under this part, 
        regarding the care episode and patient condition groups (and 
        codes) posted under subparagraph (E). In seeking such comments, 
        the Secretary shall use one or more mechanisms (other than 
        notice and comment rulemaking) that may include use of open 
        door forums, town hall meetings, or other appropriate 
        mechanisms.
            ``(G) Operational list of care episode and patient 
        condition groups and codes.--Not later than 270 days after the 
        end of the comment period described in subparagraph (F), taking 
        into account the comments received under such subparagraph, the 
        Secretary shall post on the Internet website of the Centers for 
        Medicare & Medicaid Services an operational list of care 
        episode and patient condition codes (and the criteria and 
        characteristics assigned to such code).
            ``(H) Subsequent revisions.--Not later than November 1 of 
        each year (beginning with 2018), the Secretary shall, through 
        rulemaking, make revisions to the operational lists of care 
        episode and patient condition codes as the Secretary determines 
        may be appropriate. Such revisions may be based on experience, 
        new information developed pursuant to subsection (n)(9)(A), and 
        input from the physician specialty societies, applicable 
        practitioner organizations, and other stakeholders, including 
        representatives of individuals entitled to benefits under part 
        A or enrolled under this part.
        ``(3) Attribution of patients to physicians or practitioners.--
            ``(A) In general.--In order to facilitate the attribution 
        of patients and episodes (in whole or in part) to one or more 
        physicians or applicable practitioners furnishing items and 
        services, the Secretary shall undertake the steps described in 
        the succeeding provisions of this paragraph.
            ``(B) Development of patient relationship categories and 
        codes.--The Secretary shall develop patient relationship 
        categories and codes that define and distinguish the 
        relationship and responsibility of a physician or applicable 
        practitioner with a patient at the time of furnishing an item 
        or service. Such patient relationship categories shall include 
        different relationships of the physician or applicable 
        practitioner to the patient (and the codes may reflect 
        combinations of such categories), such as a physician or 
        applicable practitioner who--
                ``(i) considers themself to have the primary 
            responsibility for the general and ongoing care for the 
            patient over extended periods of time;
                ``(ii) considers themself to be the lead physician or 
            practitioner and who furnishes items and services and 
            coordinates care furnished by other physicians or 
            practitioners for the patient during an acute episode;
                ``(iii) furnishes items and services to the patient on 
            a continuing basis during an acute episode of care, but in 
            a supportive rather than a lead role;
                ``(iv) furnishes items and services to the patient on 
            an occasional basis, usually at the request of another 
            physician or practitioner; or
                ``(v) furnishes items and services only as ordered by 
            another physician or practitioner.
            ``(C) Draft list of patient relationship categories and 
        codes.--Not later than one year after the date of the enactment 
        of this subsection, the Secretary shall post on the Internet 
        website of the Centers for Medicare & Medicaid Services a draft 
        list of the patient relationship categories and codes developed 
        under subparagraph (B).
            ``(D) Stakeholder input.--The Secretary shall seek, through 
        the date that is 120 days after the Secretary posts the list 
        pursuant to subparagraph (C), comments from physician specialty 
        societies, applicable practitioner organizations, and other 
        stakeholders, including representatives of individuals entitled 
        to benefits under part A or enrolled under this part, regarding 
        the patient relationship categories and codes posted under 
        subparagraph (C). In seeking such comments, the Secretary shall 
        use one or more mechanisms (other than notice and comment 
        rulemaking) that may include open door forums, town hall 
        meetings, web-based forums, or other appropriate mechanisms.
            ``(E) Operational list of patient relationship categories 
        and codes.--Not later than 240 days after the end of the 
        comment period described in subparagraph (D), taking into 
        account the comments received under such subparagraph, the 
        Secretary shall post on the Internet website of the Centers for 
        Medicare & Medicaid Services an operational list of patient 
        relationship categories and codes.
            ``(F) Subsequent revisions.--Not later than November 1 of 
        each year (beginning with 2018), the Secretary shall, through 
        rulemaking, make revisions to the operational list of patient 
        relationship categories and codes as the Secretary determines 
        appropriate. Such revisions may be based on experience, new 
        information developed pursuant to subsection (n)(9)(A), and 
        input from the physician specialty societies, applicable 
        practitioner organizations, and other stakeholders, including 
        representatives of individuals entitled to benefits under part 
        A or enrolled under this part.
        ``(4) Reporting of information for resource use measurement.--
    Claims submitted for items and services furnished by a physician or 
    applicable practitioner on or after January 1, 2018, shall, as 
    determined appropriate by the Secretary, include--
            ``(A) applicable codes established under paragraphs (2) and 
        (3); and
            ``(B) the national provider identifier of the ordering 
        physician or applicable practitioner (if different from the 
        billing physician or applicable practitioner).
        ``(5) Methodology for resource use analysis.--
            ``(A) In general.--In order to evaluate the resources used 
        to treat patients (with respect to care episode and patient 
        condition groups), the Secretary shall, as the Secretary 
        determines appropriate--
                ``(i) use the patient relationship codes reported on 
            claims pursuant to paragraph (4) to attribute patients (in 
            whole or in part) to one or more physicians and applicable 
            practitioners;
                ``(ii) use the care episode and patient condition codes 
            reported on claims pursuant to paragraph (4) as a basis to 
            compare similar patients and care episodes and patient 
            condition groups; and
                ``(iii) conduct an analysis of resource use (with 
            respect to care episodes and patient condition groups of 
            such patients).
            ``(B) Analysis of patients of physicians and 
        practitioners.--In conducting the analysis described in 
        subparagraph (A)(iii) with respect to patients attributed to 
        physicians and applicable practitioners, the Secretary shall, 
        as feasible--
                ``(i) use the claims data experience of such patients 
            by patient condition codes during a common period, such as 
            12 months; and
                ``(ii) use the claims data experience of such patients 
            by care episode codes--

                    ``(I) in the case of episodes without a 
                hospitalization, during periods of time (such as the 
                number of days) determined appropriate by the 
                Secretary; and
                    ``(II) in the case of episodes with a 
                hospitalization, during periods of time (such as the 
                number of days) before, during, and after the 
                hospitalization.

            ``(C) Measurement of resource use.--In measuring such 
        resource use, the Secretary--
                ``(i) shall use per patient total allowed charges for 
            all services under part A and this part (and, if the 
            Secretary determines appropriate, part D) for the analysis 
            of patient resource use, by care episode codes and by 
            patient condition codes; and
                ``(ii) may, as determined appropriate, use other 
            measures of allowed charges (such as subtotals for 
            categories of items and services) and measures of 
            utilization of items and services (such as frequency of 
            specific items and services and the ratio of specific items 
            and services among attributed patients or episodes).
            ``(D) Stakeholder input.--The Secretary shall seek comments 
        from the physician specialty societies, applicable practitioner 
        organizations, and other stakeholders, including 
        representatives of individuals entitled to benefits under part 
        A or enrolled under this part, regarding the resource use 
        methodology established pursuant to this paragraph. In seeking 
        comments the Secretary shall use one or more mechanisms (other 
        than notice and comment rulemaking) that may include open door 
        forums, town hall meetings, web-based forums, or other 
        appropriate mechanisms.
        ``(6) Implementation.--To the extent that the Secretary 
    contracts with an entity to carry out any part of the provisions of 
    this subsection, the Secretary may not contract with an entity or 
    an entity with a subcontract if the entity or subcontracting entity 
    currently makes recommendations to the Secretary on relative values 
    for services under the fee schedule for physicians' services under 
    this section.
        ``(7) Limitation.--There shall be no administrative or judicial 
    review under section 1869, section 1878, or otherwise of--
            ``(A) care episode and patient condition groups and codes 
        established under paragraph (2);
            ``(B) patient relationship categories and codes established 
        under paragraph (3); and
            ``(C) measurement of, and analyses of resource use with 
        respect to, care episode and patient condition codes and 
        patient relationship codes pursuant to paragraph (5).
        ``(8) Administration.--Chapter 35 of title 44, United States 
    Code, shall not apply to this section.
        ``(9) Definitions.--In this subsection:
            ``(A) Physician.--The term `physician' has the meaning 
        given such term in section 1861(r)(1).
            ``(B) Applicable practitioner.--The term `applicable 
        practitioner' means--
                ``(i) a physician assistant, nurse practitioner, and 
            clinical nurse specialist (as such terms are defined in 
            section 1861(aa)(5)), and a certified registered nurse 
            anesthetist (as defined in section 1861(bb)(2)); and
                ``(ii) beginning January 1, 2019, such other eligible 
            professionals (as defined in subsection (k)(3)(B)) as 
            specified by the Secretary.
        ``(10) Clarification.--The provisions of sections 1890(b)(7) 
    and 1890A shall not apply to this subsection.''.
    SEC. 102. PRIORITIES AND FUNDING FOR MEASURE DEVELOPMENT.
    Section 1848 of the Social Security Act (42 U.S.C. 1395w-4), as 
amended by subsections (c) and (f) of section 101, is further amended 
by inserting at the end the following new subsection:
    ``(s) Priorities and Funding for Measure Development.--
        ``(1) Plan identifying measure development priorities and 
    timelines.--
            ``(A) Draft measure development plan.--Not later than 
        January 1, 2016, the Secretary shall develop, and post on the 
        Internet website of the Centers for Medicare & Medicaid 
        Services, a draft plan for the development of quality measures 
        for application under the applicable provisions (as defined in 
        paragraph (5)). Under such plan the Secretary shall--
                ``(i) address how measures used by private payers and 
            integrated delivery systems could be incorporated under 
            title XVIII;
                ``(ii) describe how coordination, to the extent 
            possible, will occur across organizations developing such 
            measures; and
                ``(iii) take into account how clinical best practices 
            and clinical practice guidelines should be used in the 
            development of quality measures.
            ``(B) Quality domains.--For purposes of this subsection, 
        the term `quality domains' means at least the following 
        domains:
                ``(i) Clinical care.
                ``(ii) Safety.
                ``(iii) Care coordination.
                ``(iv) Patient and caregiver experience.
                ``(v) Population health and prevention.
            ``(C) Consideration.--In developing the draft plan under 
        this paragraph, the Secretary shall consider--
                ``(i) gap analyses conducted by the entity with a 
            contract under section 1890(a) or other contractors or 
            entities;
                ``(ii) whether measures are applicable across health 
            care settings;
                ``(iii) clinical practice improvement activities 
            submitted under subsection (q)(2)(C)(iv) for identifying 
            possible areas for future measure development and 
            identifying existing gaps with respect to such measures; 
            and
                ``(iv) the quality domains applied under this 
            subsection.
            ``(D) Priorities.--In developing the draft plan under this 
        paragraph, the Secretary shall give priority to the following 
        types of measures:
                ``(i) Outcome measures, including patient reported 
            outcome and functional status measures.
                ``(ii) Patient experience measures.
                ``(iii) Care coordination measures.
                ``(iv) Measures of appropriate use of services, 
            including measures of over use.
            ``(E) Stakeholder input.--The Secretary shall accept 
        through March 1, 2016, comments on the draft plan posted under 
        paragraph (1)(A) from the public, including health care 
        providers, payers, consumers, and other stakeholders.
            ``(F) Final measure development plan.--Not later than May 
        1, 2016, taking into account the comments received under this 
        subparagraph, the Secretary shall finalize the plan and post on 
        the Internet website of the Centers for Medicare & Medicaid 
        Services an operational plan for the development of quality 
        measures for use under the applicable provisions. Such plan 
        shall be updated as appropriate.
        ``(2) Contracts and other arrangements for quality measure 
    development.--
            ``(A) In general.--The Secretary shall enter into contracts 
        or other arrangements with entities for the purpose of 
        developing, improving, updating, or expanding in accordance 
        with the plan under paragraph (1) quality measures for 
        application under the applicable provisions. Such entities 
        shall include organizations with quality measure development 
        expertise.
            ``(B) Prioritization.--
                ``(i) In general.--In entering into contracts or other 
            arrangements under subparagraph (A), the Secretary shall 
            give priority to the development of the types of measures 
            described in paragraph (1)(D).
                ``(ii) Consideration.--In selecting measures for 
            development under this subsection, the Secretary shall 
            consider--

                    ``(I) whether such measures would be electronically 
                specified; and
                    ``(II) clinical practice guidelines to the extent 
                that such guidelines exist.

        ``(3) Annual report by the secretary.--
            ``(A) In general.--Not later than May 1, 2017, and annually 
        thereafter, the Secretary shall post on the Internet website of 
        the Centers for Medicare & Medicaid Services a report on the 
        progress made in developing quality measures for application 
        under the applicable provisions.
            ``(B) Requirements.--Each report submitted pursuant to 
        subparagraph (A) shall include the following:
                ``(i) A description of the Secretary's efforts to 
            implement this paragraph.
                ``(ii) With respect to the measures developed during 
            the previous year--

                    ``(I) a description of the total number of quality 
                measures developed and the types of such measures, such 
                as an outcome or patient experience measure;
                    ``(II) the name of each measure developed;
                    ``(III) the name of the developer and steward of 
                each measure;
                    ``(IV) with respect to each type of measure, an 
                estimate of the total amount expended under this title 
                to develop all measures of such type; and
                    ``(V) whether the measure would be electronically 
                specified.

                ``(iii) With respect to measures in development at the 
            time of the report--

                    ``(I) the information described in clause (ii), if 
                available; and
                    ``(II) a timeline for completion of the development 
                of such measures.

                ``(iv) A description of any updates to the plan under 
            paragraph (1) (including newly identified gaps and the 
            status of previously identified gaps) and the inventory of 
            measures applicable under the applicable provisions.
                ``(v) Other information the Secretary determines to be 
            appropriate.
        ``(4) Stakeholder input.--With respect to paragraph (1), the 
    Secretary shall seek stakeholder input with respect to--
            ``(A) the identification of gaps where no quality measures 
        exist, particularly with respect to the types of measures 
        described in paragraph (1)(D);
            ``(B) prioritizing quality measure development to address 
        such gaps; and
            ``(C) other areas related to quality measure development 
        determined appropriate by the Secretary.
        ``(5) Definition of applicable provisions.--In this subsection, 
    the term `applicable provisions' means the following provisions:
            ``(A) Subsection (q)(2)(B)(i).
            ``(B) Section 1833(z)(2)(C).
        ``(6) Funding.--For purposes of carrying out this subsection, 
    the Secretary shall provide for the transfer, from the Federal 
    Supplementary Medical Insurance Trust Fund under section 1841, of 
    $15,000,000 to the Centers for Medicare & Medicaid Services Program 
    Management Account for each of fiscal years 2015 through 2019. 
    Amounts transferred under this paragraph shall remain available 
    through the end of fiscal year 2022.
        ``(7) Administration.--Chapter 35 of title 44, United States 
    Code, shall not apply to the collection of information for the 
    development of quality measures.''.
    SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDIVIDUALS WITH CHRONIC 
      CARE NEEDS.
    (a) In General.--Section 1848(b) of the Social Security Act (42 
U.S.C. 1395w-4(b)) is amended by adding at the end the following new 
paragraph:
        ``(8) Encouraging care management for individuals with chronic 
    care needs.--
            ``(A) In general.--In order to encourage the management of 
        care for individuals with chronic care needs the Secretary 
        shall, subject to subparagraph (B), make payment (as the 
        Secretary determines to be appropriate) under this section for 
        chronic care management services furnished on or after January 
        1, 2015, by a physician (as defined in section 1861(r)(1)), 
        physician assistant or nurse practitioner (as defined in 
        section 1861(aa)(5)(A)), clinical nurse specialist (as defined 
        in section 1861(aa)(5)(B)), or certified nurse midwife (as 
        defined in section 1861(gg)(2)).
            ``(B) Policies relating to payment.--In carrying out this 
        paragraph, with respect to chronic care management services, 
        the Secretary shall--
                ``(i) make payment to only one applicable provider for 
            such services furnished to an individual during a period;
                ``(ii) not make payment under subparagraph (A) if such 
            payment would be duplicative of payment that is otherwise 
            made under this title for such services; and
                ``(iii) not require that an annual wellness visit (as 
            defined in section 1861(hhh)) or an initial preventive 
            physical examination (as defined in section 1861(ww)) be 
            furnished as a condition of payment for such management 
            services.''.
    (b) Education and Outreach.--
        (1) Campaign.--
            (A) In general.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        conduct an education and outreach campaign to inform 
        professionals who furnish items and services under part B of 
        title XVIII of the Social Security Act and individuals enrolled 
        under such part of the benefits of chronic care management 
        services described in section 1848(b)(8) of the Social Security 
        Act, as added by subsection (a), and encourage such individuals 
        with chronic care needs to receive such services.
            (B) Requirements.--Such campaign shall--
                (i) be directed by the Office of Rural Health Policy of 
            the Department of Health and Human Services and the Office 
            of Minority Health of the Centers for Medicare & Medicaid 
            Services; and
                (ii) focus on encouraging participation by underserved 
            rural populations and racial and ethnic minority 
            populations.
        (2) Report.--Not later than December 31, 2017, the Secretary 
    shall submit to Congress a report on the use of chronic care 
    management services described in such section 1848(b)(8) by 
    individuals living in rural areas and by racial and ethnic minority 
    populations. Such report shall--
            (A) identify barriers to receiving chronic care management 
        services; and
            (B) make recommendations for increasing the appropriate use 
        of chronic care management services.
    SEC. 104. EMPOWERING BENEFICIARY CHOICES THROUGH CONTINUED ACCESS 
      TO INFORMATION ON PHYSICIANS' SERVICES.
    (a) In General.--On an annual basis (beginning with 2015), the 
Secretary shall make publicly available, in an easily understandable 
format, information with respect to physicians and, as appropriate, 
other eligible professionals on items and services furnished to 
Medicare beneficiaries under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.).
    (b) Type and Manner of Information.--The information made available 
under this section shall be similar to the type of information in the 
Medicare Provider Utilization and Payment Data: Physician and Other 
Supplier Public Use File released by the Secretary with respect to 2012 
and shall be made available in a manner similar to the manner in which 
the information in such file is made available.
    (c) Requirements.--The information made available under this 
section shall include, at a minimum, the following:
        (1) Information on the number of services furnished by the 
    physician or other eligible professional under part B of title 
    XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), which 
    may include information on the most frequent services furnished or 
    groupings of services.
        (2) Information on submitted charges and payments for services 
    under such part.
        (3) A unique identifier for the physician or other eligible 
    professional that is available to the public, such as a national 
    provider identifier.
    (d) Searchability.--The information made available under this 
section shall be searchable by at least the following:
        (1) The specialty or type of the physician or other eligible 
    professional.
        (2) Characteristics of the services furnished, such as volume 
    or groupings of services.
        (3) The location of the physician or other eligible 
    professional.
    (e) Integration on Physician Compare.--Beginning with 2016, the 
Secretary shall integrate the information made available under this 
section on Physician Compare.
    (f) Definitions.--In this section:
        (1) Eligible professional; physician; secretary.--The terms 
    ``eligible professional'', ``physician'', and ``Secretary'' have 
    the meaning given such terms in section 10331(i) of Public Law 111-
    148.
        (2) Physician compare.--The term ``Physician Compare'' means 
    the Physician Compare Internet website of the Centers for Medicare 
    & Medicaid Services (or a successor website).
    SEC. 105. EXPANDING AVAILABILITY OF MEDICARE DATA.
    (a) Expanding Uses of Medicare Data by Qualified Entities.--
        (1) Additional analyses.--
            (A) In general.--Subject to subparagraph (B), to the extent 
        consistent with applicable information, privacy, security, and 
        disclosure laws (including paragraph (3)), notwithstanding 
        paragraph (4)(B) of section 1874(e) of the Social Security Act 
        (42 U.S.C. 1395kk(e)) and the second sentence of paragraph 
        (4)(D) of such section, beginning July 1, 2016, a qualified 
        entity may use the combined data described in paragraph 
        (4)(B)(iii) of such section received by such entity under such 
        section, and information derived from the evaluation described 
        in such paragraph (4)(D), to conduct additional non-public 
        analyses (as determined appropriate by the Secretary) and 
        provide or sell such analyses to authorized users for non-
        public use (including for the purposes of assisting providers 
        of services and suppliers to develop and participate in quality 
        and patient care improvement activities, including developing 
        new models of care).
            (B) Limitations with respect to analyses.--
                (i) Employers.--Any analyses provided or sold under 
            subparagraph (A) to an employer described in paragraph 
            (9)(A)(iii) may only be used by such employer for purposes 
            of providing health insurance to employees and retirees of 
            the employer.
                (ii) Health insurance issuers.--A qualified entity may 
            not provide or sell an analysis to a health insurance 
            issuer described in paragraph (9)(A)(iv) unless the issuer 
            is providing the qualified entity with data under section 
            1874(e)(4)(B)(iii) of the Social Security Act (42 U.S.C. 
            1395kk(e)(4)(B)(iii)).
        (2) Access to certain data.--
            (A) Access.--To the extent consistent with applicable 
        information, privacy, security, and disclosure laws (including 
        paragraph (3)), notwithstanding paragraph (4)(B) of section 
        1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) and 
        the second sentence of paragraph (4)(D) of such section, 
        beginning July 1, 2016, a qualified entity may--
                (i) provide or sell the combined data described in 
            paragraph (4)(B)(iii) of such section to authorized users 
            described in clauses (i), (ii), and (v) of paragraph (9)(A) 
            for non-public use, including for the purposes described in 
            subparagraph (B); or
                (ii) subject to subparagraph (C), provide Medicare 
            claims data to authorized users described in clauses (i), 
            (ii), and (v), of paragraph (9)(A) for non-public use, 
            including for the purposes described in subparagraph (B).
            (B) Purposes described.--The purposes described in this 
        subparagraph are assisting providers of services and suppliers 
        in developing and participating in quality and patient care 
        improvement activities, including developing new models of 
        care.
            (C) Medicare claims data must be provided at no cost.--A 
        qualified entity may not charge a fee for providing the data 
        under subparagraph (A)(ii).
        (3) Protection of information.--
            (A) In general.--Except as provided in subparagraph (B), an 
        analysis or data that is provided or sold under paragraph (1) 
        or (2) shall not contain information that individually 
        identifies a patient.
            (B) Information on patients of the provider of services or 
        supplier.--To the extent consistent with applicable 
        information, privacy, security, and disclosure laws, an 
        analysis or data that is provided or sold to a provider of 
        services or supplier under paragraph (1) or (2) may contain 
        information that individually identifies a patient of such 
        provider or supplier, including with respect to items and 
        services furnished to the patient by other providers of 
        services or suppliers.
            (C) Prohibition on using analyses or data for marketing 
        purposes.--An authorized user shall not use an analysis or data 
        provided or sold under paragraph (1) or (2) for marketing 
        purposes.
        (4) Data use agreement.--A qualified entity and an authorized 
    user described in clauses (i), (ii), and (v) of paragraph (9)(A) 
    shall enter into an agreement regarding the use of any data that 
    the qualified entity is providing or selling to the authorized user 
    under paragraph (2). Such agreement shall describe the requirements 
    for privacy and security of the data and, as determined appropriate 
    by the Secretary, any prohibitions on using such data to link to 
    other individually identifiable sources of information. If the 
    authorized user is not a covered entity under the rules promulgated 
    pursuant to the Health Insurance Portability and Accountability Act 
    of 1996, the agreement shall identify the relevant regulations, as 
    determined by the Secretary, that the user shall comply with as if 
    it were acting in the capacity of such a covered entity.
        (5) No redisclosure of analyses or data.--
            (A) In general.--Except as provided in subparagraph (B), an 
        authorized user that is provided or sold an analysis or data 
        under paragraph (1) or (2) shall not redisclose or make public 
        such analysis or data or any analysis using such data.
            (B) Permitted redisclosure.--A provider of services or 
        supplier that is provided or sold an analysis or data under 
        paragraph (1) or (2) may, as determined by the Secretary, 
        redisclose such analysis or data for the purposes of 
        performance improvement and care coordination activities but 
        shall not make public such analysis or data or any analysis 
        using such data.
        (6) Opportunity for providers of services and suppliers to 
    review.--Prior to a qualified entity providing or selling an 
    analysis to an authorized user under paragraph (1), to the extent 
    that such analysis would individually identify a provider of 
    services or supplier who is not being provided or sold such 
    analysis, such qualified entity shall provide such provider or 
    supplier with the opportunity to appeal and correct errors in the 
    manner described in section 1874(e)(4)(C)(ii) of the Social 
    Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)).
        (7) Assessment for a breach.--
            (A) In general.--In the case of a breach of a data use 
        agreement under this section or section 1874(e) of the Social 
        Security Act (42 U.S.C. 1395kk(e)), the Secretary shall impose 
        an assessment on the qualified entity both in the case of--
                (i) an agreement between the Secretary and a qualified 
            entity; and
                (ii) an agreement between a qualified entity and an 
            authorized user.
            (B) Assessment.--The assessment under subparagraph (A) 
        shall be an amount up to $100 for each individual entitled to, 
        or enrolled for, benefits under part A of title XVIII of the 
        Social Security Act or enrolled for benefits under part B of 
        such title--
                (i) in the case of an agreement described in 
            subparagraph (A)(i), for whom the Secretary provided data 
            on to the qualified entity under paragraph (2); and
                (ii) in the case of an agreement described in 
            subparagraph (A)(ii), for whom the qualified entity 
            provided data on to the authorized user under paragraph 
            (2).
            (C) Deposit of amounts collected.--Any amounts collected 
        pursuant to this paragraph shall be deposited in Federal 
        Supplementary Medical Insurance Trust Fund under section 1841 
        of the Social Security Act (42 U.S.C. 1395t).
        (8) Annual reports.--Any qualified entity that provides or 
    sells an analysis or data under paragraph (1) or (2) shall annually 
    submit to the Secretary a report that includes--
            (A) a summary of the analyses provided or sold, including 
        the number of such analyses, the number of purchasers of such 
        analyses, and the total amount of fees received for such 
        analyses;
            (B) a description of the topics and purposes of such 
        analyses;
            (C) information on the entities who received the data under 
        paragraph (2), the uses of the data, and the total amount of 
        fees received for providing, selling, or sharing the data; and
            (D) other information determined appropriate by the 
        Secretary.
        (9) Definitions.--In this subsection and subsection (b):
            (A) Authorized user.--The term ``authorized user'' means 
        the following:
                (i) A provider of services.
                (ii) A supplier.
                (iii) An employer (as defined in section 3(5) of the 
            Employee Retirement Insurance Security Act of 1974).
                (iv) A health insurance issuer (as defined in section 
            2791 of the Public Health Service Act).
                (v) A medical society or hospital association.
                (vi) Any entity not described in clauses (i) through 
            (v) that is approved by the Secretary (other than an 
            employer or health insurance issuer not described in 
            clauses (iii) and (iv), respectively, as determined by the 
            Secretary).
            (B) Provider of services.--The term ``provider of 
        services'' has the meaning given such term in section 1861(u) 
        of the Social Security Act (42 U.S.C. 1395x(u)).
            (C) Qualified entity.--The term ``qualified entity'' has 
        the meaning given such term in section 1874(e)(2) of the Social 
        Security Act (42 U.S.C. 1395kk(e)).
            (D) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (E) Supplier.--The term ``supplier'' has the meaning given 
        such term in section 1861(d) of the Social Security Act (42 
        U.S.C. 1395x(d)).
    (b) Access to Medicare Data by Qualified Clinical Data Registries 
To Facilitate Quality Improvement.--
        (1) Access.--
            (A) In general.--To the extent consistent with applicable 
        information, privacy, security, and disclosure laws, beginning 
        July 1, 2016, the Secretary shall, at the request of a 
        qualified clinical data registry under section 1848(m)(3)(E) of 
        the Social Security Act (42 U.S.C. 1395w-4(m)(3)(E)), provide 
        the data described in subparagraph (B) (in a form and manner 
        determined to be appropriate) to such qualified clinical data 
        registry for purposes of linking such data with clinical 
        outcomes data and performing risk-adjusted, scientifically 
        valid analyses and research to support quality improvement or 
        patient safety, provided that any public reporting of such 
        analyses or research that identifies a provider of services or 
        supplier shall only be conducted with the opportunity of such 
        provider or supplier to appeal and correct errors in the manner 
        described in subsection (a)(6).
            (B) Data described.--The data described in this 
        subparagraph is--
                (i) claims data under the Medicare program under title 
            XVIII of the Social Security Act; and
                (ii) if the Secretary determines appropriate, claims 
            data under the Medicaid program under title XIX of such Act 
            and the State Children's Health Insurance Program under 
            title XXI of such Act.
        (2) Fee.--Data described in paragraph (1)(B) shall be provided 
    to a qualified clinical data registry under paragraph (1) at a fee 
    equal to the cost of providing such data. Any fee collected 
    pursuant to the preceding sentence shall be deposited in the 
    Centers for Medicare & Medicaid Services Program Management 
    Account.
    (c) Expansion of Data Available to Qualified Entities.--Section 
1874(e) of the Social Security Act (42 U.S.C. 1395kk(e)) is amended--
        (1) in the subsection heading, by striking ``Medicare''; and
        (2) in paragraph (3)--
            (A) by inserting after the first sentence the following new 
        sentence: ``Beginning July 1, 2016, if the Secretary determines 
        appropriate, the data described in this paragraph may also 
        include standardized extracts (as determined by the Secretary) 
        of claims data under titles XIX and XXI for assistance provided 
        under such titles for one or more specified geographic areas 
        and time periods requested by a qualified entity.''; and
            (B) in the last sentence, by inserting ``or under titles 
        XIX or XXI'' before the period at the end.
    (d) Revision of Placement of Fees.--Section 1874(e)(4)(A) of the 
Social Security Act (42 U.S.C. 1395kk(e)(4)(A)) is amended, in the 
second sentence--
        (1) by inserting ``, for periods prior to July 1, 2016,'' after 
    ``deposited''; and
        (2) by inserting the following before the period at the end: 
    ``, and, beginning July 1, 2016, into the Centers for Medicare & 
    Medicaid Services Program Management Account''.
    SEC. 106. REDUCING ADMINISTRATIVE BURDEN AND OTHER PROVISIONS.
    (a) Medicare Physician and Practitioner Opt-Out to Private 
Contract.--
        (1) Indefinite, continuing automatic extension of opt out 
    election.--
            (A) In general.--Section 1802(b)(3) of the Social Security 
        Act (42 U.S.C. 1395a(b)(3)) is amended--
                (i) in subparagraph (B)(ii), by striking ``during the 
            2-year period beginning on the date the affidavit is 
            signed'' and inserting ``during the applicable 2-year 
            period (as defined in subparagraph (D))'';
                (ii) in subparagraph (C), by striking ``during the 2-
            year period described in subparagraph (B)(ii)'' and 
            inserting ``during the applicable 2-year period''; and
                (iii) by adding at the end the following new 
            subparagraph:
            ``(D) Applicable 2-year periods for effectiveness of 
        affidavits.--In this subsection, the term `applicable 2-year 
        period' means, with respect to an affidavit of a physician or 
        practitioner under subparagraph (B), the 2-year period 
        beginning on the date the affidavit is signed and includes each 
        subsequent 2-year period unless the physician or practitioner 
        involved provides notice to the Secretary (in a form and manner 
        specified by the Secretary), not later than 30 days before the 
        end of the previous 2-year period, that the physician or 
        practitioner does not want to extend the application of the 
        affidavit for such subsequent 2-year period.''.
            (B) Effective date.--The amendments made by subparagraph 
        (A) shall apply to affidavits entered into on or after the date 
        that is 60 days after the date of the enactment of this Act.
        (2) Public availability of information on opt-out physicians 
    and practitioners.--Section 1802(b) of the Social Security Act (42 
    U.S.C. 1395a(b)) is amended--
            (A) in paragraph (5), by adding at the end the following 
        new subparagraph:
        ``(D) Opt-out physician or practitioner.--The term `opt-out 
    physician or practitioner' means a physician or practitioner who 
    has in effect an affidavit under paragraph (3)(B).'';
            (B) by redesignating paragraph (5) as paragraph (6); and
            (C) by inserting after paragraph (4) the following new 
        paragraph:
        ``(5) Posting of information on opt-out physicians and 
    practitioners.--
            ``(A) In general.--Beginning not later than February 1, 
        2016, the Secretary shall make publicly available through an 
        appropriate publicly accessible website of the Department of 
        Health and Human Services information on the number and 
        characteristics of opt-out physicians and practitioners and 
        shall update such information on such website not less often 
        than annually.
            ``(B) Information to be included.--The information to be 
        made available under subparagraph (A) shall include at least 
        the following with respect to opt-out physicians and 
        practitioners:
                ``(i) Their number.
                ``(ii) Their physician or professional specialty or 
            other designation.
                ``(iii) Their geographic distribution.
                ``(iv) The timing of their becoming opt-out physicians 
            and practitioners, relative, to the extent feasible, to 
            when they first enrolled in the program under this title 
            and with respect to applicable 2-year periods.
                ``(v) The proportion of such physicians and 
            practitioners who billed for emergency or urgent care 
            services.''.
    (b) Promoting Interoperability of Electronic Health Record 
Systems.--
        (1) Recommendations for achieving widespread ehr 
    interoperability.--
            (A) Objective.--As a consequence of a significant Federal 
        investment in the implementation of health information 
        technology through the Medicare and Medicaid EHR incentive 
        programs, Congress declares it a national objective to achieve 
        widespread exchange of health information through interoperable 
        certified EHR technology nationwide by December 31, 2018.
            (B) Definitions.--In this paragraph:
                (i) Widespread interoperability.--The term ``widespread 
            interoperability'' means interoperability between certified 
            EHR technology systems employed by meaningful EHR users 
            under the Medicare and Medicaid EHR incentive programs and 
            other clinicians and health care providers on a nationwide 
            basis.
                (ii) Interoperability.--The term ``interoperability'' 
            means the ability of two or more health information systems 
            or components to exchange clinical and other information 
            and to use the information that has been exchanged using 
            common standards as to provide access to longitudinal 
            information for health care providers in order to 
            facilitate coordinated care and improved patient outcomes.
            (C) Establishment of metrics.--Not later than July 1, 2016, 
        and in consultation with stakeholders, the Secretary shall 
        establish metrics to be used to determine if and to the extent 
        that the objective described in subparagraph (A) has been 
        achieved.
            (D) Recommendations if objective not achieved.--If the 
        Secretary of Health and Human Services determines that the 
        objective described in subparagraph (A) has not been achieved 
        by December 31, 2018, then the Secretary shall submit to 
        Congress a report, by not later than December 31, 2019, that 
        identifies barriers to such objective and recommends actions 
        that the Federal Government can take to achieve such objective. 
        Such recommended actions may include recommendations--
                (i) to adjust payments for not being meaningful EHR 
            users under the Medicare EHR incentive programs; and
                (ii) for criteria for decertifying certified EHR 
            technology products.
        (2) Preventing blocking the sharing of information.--
            (A) For meaningful use ehr professionals.--Section 
        1848(o)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395w-
        4(o)(2)(A)(ii)) is amended by inserting before the period at 
        the end the following: ``, and the professional demonstrates 
        (through a process specified by the Secretary, such as the use 
        of an attestation) that the professional has not knowingly and 
        willfully taken action (such as to disable functionality) to 
        limit or restrict the compatibility or interoperability of the 
        certified EHR technology''.
            (B) For meaningful use ehr hospitals.--Section 
        1886(n)(3)(A)(ii) of the Social Security Act (42 U.S.C. 
        1395ww(n)(3)(A)(ii)) is amended by inserting before the period 
        at the end the following: ``, and the hospital demonstrates 
        (through a process specified by the Secretary, such as the use 
        of an attestation) that the hospital has not knowingly and 
        willfully taken action (such as to disable functionality) to 
        limit or restrict the compatibility or interoperability of the 
        certified EHR technology''.
            (C) Effective date.--The amendments made by this subsection 
        shall apply to meaningful EHR users as of the date that is one 
        year after the date of the enactment of this Act.
        (3) Study and report on the feasibility of establishing a 
    mechanism to compare certified ehr technology products.--
            (A) Study.--The Secretary shall conduct a study to examine 
        the feasibility of establishing one or more mechanisms to 
        assist providers in comparing and selecting certified EHR 
        technology products. Such mechanisms may include--
                (i) a website with aggregated results of surveys of 
            meaningful EHR users on the functionality of certified EHR 
            technology products to enable such users to directly 
            compare the functionality and other features of such 
            products; and
                (ii) information from vendors of certified products 
            that is made publicly available in a standardized format.
        The aggregated results of the surveys described in clause (i) 
        may be made available through contracts with physicians, 
        hospitals, or other organizations that maintain such 
        comparative information described in such clause.
            (B) Report.--Not later than 1 year after the date of the 
        enactment of this Act, the Secretary shall submit to Congress a 
        report on mechanisms that would assist providers in comparing 
        and selecting certified EHR technology products. The report 
        shall include information on the benefits of, and resources 
        needed to develop and maintain, such mechanisms.
        (4) Definitions.--In this subsection:
            (A) The term ``certified EHR technology'' has the meaning 
        given such term in section 1848(o)(4) of the Social Security 
        Act (42 U.S.C. 1395w-4(o)(4)).
            (B) The term ``meaningful EHR user'' has the meaning given 
        such term under the Medicare EHR incentive programs.
            (C) The term ``Medicare and Medicaid EHR incentive 
        programs'' means--
                (i) in the case of the Medicare program under title 
            XVIII of the Social Security Act, the incentive programs 
            under section 1814(l)(3), section 1848(o), subsections (l) 
            and (m) of section 1853, and section 1886(n) of the Social 
            Security Act (42 U.S.C. 1395f(l)(3), 1395w-4(o), 1395w-23, 
            1395ww(n)); and
                (ii) in the case of the Medicaid program under title 
            XIX of such Act, the incentive program under subsections 
            (a)(3)(F) and (t) of section 1903 of such Act (42 U.S.C. 
            1396b).
            (D) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
    (c) GAO Studies and Reports on the Use of Telehealth Under Federal 
Programs and on Remote Patient Monitoring Services.--
        (1) Study on telehealth services.--The Comptroller General of 
    the United States shall conduct a study on the following:
            (A) How the definition of telehealth across various Federal 
        programs and Federal efforts can inform the use of telehealth 
        in the Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (B) Issues that can facilitate or inhibit the use of 
        telehealth under the Medicare program under such title, 
        including oversight and professional licensure, changing 
        technology, privacy and security, infrastructure requirements, 
        and varying needs across urban and rural areas.
            (C) Potential implications of greater use of telehealth 
        with respect to payment and delivery system transformations 
        under the Medicare program under such title XVIII and the 
        Medicaid program under title XIX of such Act (42 U.S.C. 1396 et 
        seq.).
            (D) How the Centers for Medicare & Medicaid Services 
        monitors payments made under the Medicare program under such 
        title XVIII to providers for telehealth services.
        (2) Study on remote patient monitoring services.--
            (A) In general.--The Comptroller General of the United 
        States shall conduct a study--
                (i) of the dissemination of remote patient monitoring 
            technology in the private health insurance market;
                (ii) of the financial incentives in the private health 
            insurance market relating to adoption of such technology;
                (iii) of the barriers to adoption of such services 
            under the Medicare program under title XVIII of the Social 
            Security Act;
                (iv) that evaluates the patients, conditions, and 
            clinical circumstances that could most benefit from remote 
            patient monitoring services; and
                (v) that evaluates the challenges related to 
            establishing appropriate valuation for remote patient 
            monitoring services under the Medicare physician fee 
            schedule under section 1848 of the Social Security Act (42 
            U.S.C. 1395w-4) in order to accurately reflect the 
            resources involved in furnishing such services.
            (B) Definitions.--For purposes of this paragraph:
                (i) Remote patient monitoring services.--The term 
            ``remote patient monitoring services'' means services 
            furnished through remote patient monitoring technology.
                (ii) Remote patient monitoring technology.--The term 
            ``remote patient monitoring technology'' means a 
            coordinated system that uses one or more home-based or 
            mobile monitoring devices that automatically transmit vital 
            sign data or information on activities of daily living and 
            may include responses to assessment questions collected on 
            the devices wirelessly or through a telecommunications 
            connection to a server that complies with the Federal 
            regulations (concerning the privacy of individually 
            identifiable health information) promulgated under section 
            264(c) of the Health Insurance Portability and 
            Accountability Act of 1996, as part of an established plan 
            of care for that patient that includes the review and 
            interpretation of that data by a health care professional.
        (3) Reports.--Not later than 24 months after the date of the 
    enactment of this Act, the Comptroller General shall submit to 
    Congress--
            (A) a report containing the results of the study conducted 
        under paragraph (1); and
            (B) a report containing the results of the study conducted 
        under paragraph (2).
    A report required under this paragraph shall be submitted together 
    with recommendations for such legislation and administrative action 
    as the Comptroller General determines appropriate. The Comptroller 
    General may submit one report containing the results described in 
    subparagraphs (A) and (B) and the recommendations described in the 
    previous sentence.
    (d) Rule of Construction Regarding Health Care Providers.--
        (1) In general.--Subject to paragraph (3), the development, 
    recognition, or implementation of any guideline or other standard 
    under any Federal health care provision shall not be construed to 
    establish the standard of care or duty of care owed by a health 
    care provider to a patient in any medical malpractice or medical 
    product liability action or claim.
        (2) Definitions.--For purposes of this subsection:
            (A) Federal health care provision.--The term ``Federal 
        health care provision'' means any provision of the Patient 
        Protection and Affordable Care Act (Public Law 111-148), title 
        I or subtitle B of title II of the Health Care and Education 
        Reconciliation Act of 2010 (Public Law 111-152), or title XVIII 
        or XIX of the Social Security Act (42 U.S.C. 1395 et seq., 42 
        U.S.C. 1396 et seq.).
            (B) Health care provider.--The term ``health care 
        provider'' means any individual, group practice, corporation of 
        health care professionals, or hospital--
                (i) licensed, registered, or certified under Federal or 
            State laws or regulations to provide health care services; 
            or
                (ii) required to be so licensed, registered, or 
            certified but that is exempted by other statute or 
            regulation.
            (C) Medical malpractice or medical product liability action 
        or claim.--The term ``medical malpractice or medical product 
        liability action or claim'' means a medical malpractice action 
        or claim (as defined in section 431(7) of the Health Care 
        Quality Improvement Act of 1986 (42 U.S.C. 11151(7))) and 
        includes a liability action or claim relating to a health care 
        provider's prescription or provision of a drug, device, or 
        biological product (as such terms are defined in section 201 of 
        the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321) or 
        section 351 of the Public Health Service Act (42 U.S.C. 262)).
            (D) State.--The term ``State'' includes the District of 
        Columbia, Puerto Rico, and any other commonwealth, possession, 
        or territory of the United States.
        (3) No preemption.--Nothing in paragraph (1) or any provision 
    of the Patient Protection and Affordable Care Act (Public Law 111-
    148), title I or subtitle B of title II of the Health Care and 
    Education Reconciliation Act of 2010 (Public Law 111-152), or title 
    XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq., 42 
    U.S.C. 1396 et seq.) shall be construed to preempt any State or 
    common law governing medical professional or medical product 
    liability actions or claims.

             TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS
                     Subtitle A--Medicare Extenders

    SEC. 201. EXTENSION OF WORK GPCI FLOOR.
    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``April 1, 2015'' and inserting 
``January 1, 2018''.
    SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS.
    (a) In General.--Section 1833(g) of the Social Security Act (42 
U.S.C. 1395l(g)) is amended--
        (1) in paragraph (5)(A), in the first sentence, by striking 
    ``March 31, 2015'' and inserting ``December 31, 2017''; and
        (2) in paragraph (6)(A)--
            (A) by striking ``March 31, 2015'' and inserting ``December 
        31, 2017''; and
            (B) by striking ``2012, 2013, 2014, or the first three 
        months of 2015'' and inserting ``2012 through 2017''.
    (b) Targeted Reviews Under Manual Medical Review Process for 
Outpatient Therapy Services.--
        (1) In general.--Section 1833(g)(5) of the Social Security Act 
    (42 U.S.C. 1395l(g)(5)) is amended--
            (A) in subparagraph (C)(i), by inserting ``, subject to 
        subparagraph (E),'' after ``manual medical review process 
        that''; and
            (B) by adding at the end the following new subparagraph:
    ``(E)(i) In place of the manual medical review process under 
subparagraph (C)(i), the Secretary shall implement a process for 
medical review under this subparagraph under which the Secretary shall 
identify and conduct medical review for services described in 
subparagraph (C)(i) furnished by a provider of services or supplier (in 
this subparagraph referred to as a `therapy provider') using such 
factors as the Secretary determines to be appropriate.
    ``(ii) Such factors may include the following:
        ``(I) The therapy provider has had a high claims denial 
    percentage for therapy services under this part or is less 
    compliant with applicable requirements under this title.
        ``(II) The therapy provider has a pattern of billing for 
    therapy services under this part that is aberrant compared to peers 
    or otherwise has questionable billing practices for such services, 
    such as billing medically unlikely units of services in a day.
        ``(III) The therapy provider is newly enrolled under this title 
    or has not previously furnished therapy services under this part.
        ``(IV) The services are furnished to treat a type of medical 
    condition.
        ``(V) The therapy provider is part of group that includes 
    another therapy provider identified using the factors determined 
    under this subparagraph.
    ``(iii) For purposes of carrying out this subparagraph, the 
Secretary shall provide for the transfer, from the Federal 
Supplementary Medical Insurance Trust Fund under section 1841, of 
$5,000,000 to the Centers for Medicare & Medicaid Services Program 
Management Account for fiscal years 2015 and 2016, to remain available 
until expended. Such funds may not be used by a contractor under 
section 1893(h) for medical reviews under this subparagraph.
    ``(iv) The targeted review process under this subparagraph shall 
not apply to services for which expenses are incurred beyond the period 
for which the exceptions process under subparagraph (A) is 
implemented.''.
        (2) Effective date.--The amendments made by this subsection 
    shall apply with respect to requests described in section 
    1833(g)(5)(C)(i) of the Social Security Act (42 U.S.C. 
    1395l(g)(5)(C)(i)) with respect to which the Secretary of Health 
    and Human Services has not conducted medical review under such 
    section by a date (not later than 90 days after the date of the 
    enactment of this Act) specified by the Secretary.
    SEC. 203. EXTENSION OF AMBULANCE ADD-ONS.
    (a) Ground Ambulance.--Section 1834(l)(13)(A) of the Social 
Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended by striking ``April 
1, 2015'' and inserting ``January 1, 2018'' each place it appears.
    (b) Super Rural Ground Ambulance.--Section 1834(l)(12)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, in the 
first sentence, by striking ``April 1, 2015'' and inserting ``January 
1, 2018''.
    SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT 
      ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS.
    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended--
        (1) in subparagraph (B), in the matter preceding clause (i), by 
    striking ``in fiscal year 2015 (beginning on April 1, 2015), fiscal 
    year 2016, and subsequent fiscal years'' and inserting ``in fiscal 
    year 2018 and subsequent fiscal years'';
        (2) in subparagraph (C)(i), by striking ``fiscal years 2011 
    through 2014 and fiscal year 2015 (before April 1, 2015),'' and 
    inserting ``fiscal years 2011 through 2017,'' each place it 
    appears; and
        (3) in subparagraph (D), by striking ``fiscal years 2011 
    through 2014 and fiscal year 2015 (before April 1, 2015),'' and 
    inserting ``fiscal years 2011 through 2017,''.
    SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) 
      PROGRAM.
    (a) In General.--Section 1886(d)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
        (1) in clause (i), by striking ``April 1, 2015'' and inserting 
    ``October 1, 2017''; and
        (2) in clause (ii)(II), by striking ``April 1, 2015'' and 
    inserting ``October 1, 2017''.
    (b) Conforming Amendments.--
        (1) Extension of target amount.--Section 1886(b)(3)(D) of the 
    Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended--
            (A) in the matter preceding clause (i), by striking ``April 
        1, 2015'' and inserting ``October 1, 2017''; and
            (B) in clause (iv), by striking ``through fiscal year 2014 
        and the portion of fiscal year 2015 before April 1, 2015'' and 
        inserting ``through fiscal year 2017''.
        (2) Permitting hospitals to decline reclassification.--Section 
    13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 
    U.S.C. 1395ww note) is amended by striking ``through the first 2 
    quarters of fiscal year 2015'' and inserting ``through fiscal year 
    2017''.
    SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVANTAGE PLANS FOR 
      SPECIAL NEEDS INDIVIDUALS.
    Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-
28(f)(1)) is amended by striking ``2017'' and inserting ``2019''.
    SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, 
      INPUT, AND SELECTION.
    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended by striking ``and $15,000,000 for the first 6 
months of fiscal year 2015'' and inserting ``and $30,000,000 for each 
of fiscal years 2015 through 2017''.
    SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-
      INCOME PROGRAMS.
    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for 
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended 
by section 3306 of the Patient Protection and Affordable Care Act 
(Public Law 111-148), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR 
Reform Act of 2013 (Public Law 113-67), and section 110 of the 
Protecting Access to Medicare Act of 2014 (Public Law 113-93), is 
amended--
        (1) in clause (iv), by striking ``and'' at the end;
        (2) by striking clause (v); and
        (3) by adding at the end the following new clauses:
                ``(v) for fiscal year 2015, of $7,500,000;
                ``(vi) for fiscal year 2016, of $13,000,000; and
                ``(vii) for fiscal year 2017, of $13,000,000.''.
    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
        (1) in clause (iv), by striking ``and'' at the end;
        (2) by striking clause (v); and
        (3) by inserting after clause (iv) the following new clauses:
                ``(v) for fiscal year 2015, of $7,500,000;
                ``(vi) for fiscal year 2016, of $7,500,000; and
                ``(vii) for fiscal year 2017, of $7,500,000.''.
    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
        (1) in clause (iv), by striking ``and'' at the end;
        (2) by striking clause (v); and
        (3) by inserting after clause (iv) the following new clauses:
                ``(v) for fiscal year 2015, of $5,000,000;
                ``(vi) for fiscal year 2016, of $5,000,000; and
                ``(vii) for fiscal year 2017, of $5,000,000.''.
    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended--
        (1) in clause (iv), by striking ``and'' at the end;
        (2) by striking clause (v); and
        (3) by inserting after clause (iv) the following new clauses:
                ``(v) for fiscal year 2015, of $5,000,000;
                ``(vi) for fiscal year 2016, of $12,000,000; and
                ``(vii) for fiscal year 2017, of $12,000,000.''.
    SEC. 209. EXTENSION AND TRANSITION OF REASONABLE COST REIMBURSEMENT 
      CONTRACTS.
    (a) One-Year Transition and Notice Regarding Transition.--Section 
1876(h)(5)(C) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)) is 
amended--
        (1) in clause (ii), in the matter preceding subclause (I), by 
    striking ``For any'' and inserting ``Subject to clause (iv), for 
    any'';
        (2) in clause (iii)(I), by inserting ``cost plan service'' 
    after ``With respect to any portion of the'';
        (3) in clause (iii)(II), by inserting ``cost plan service'' 
    after ``With respect to any other portion of such''; and
        (4) by adding at the end the following new clauses:
    ``(iv) In the case of an eligible organization that is offering a 
reasonable cost reimbursement contract that may no longer be extended 
or renewed because of the application of clause (ii), or where such 
contract has been extended or renewed but the eligible organization has 
informed the Secretary in writing not later than a date determined 
appropriate by the Secretary that such organization voluntarily plans 
not to seek renewal of the reasonable cost reimbursement contract, the 
following shall apply:
        ``(I) Notwithstanding such clause, such contract may be 
    extended or renewed for the two years subsequent to 2016. The final 
    year in which such contract is extended or renewed is referred to 
    in this subsection as the `last reasonable cost reimbursement 
    contract year for the contract'.
        ``(II) The organization may not enroll a new enrollee under 
    such contract during the last reasonable cost reimbursement 
    contract year for the contract (but may continue to enroll new 
    enrollees through the end of the year immediately preceding such 
    year) unless such enrollee is any of the following:
            ``(aa) An individual who chooses enrollment in the 
        reasonable cost contract during the annual election period with 
        respect to such last year.
            ``(bb) An individual whose spouse, at the time of the 
        individual's enrollment is an enrollee under the reasonable 
        cost reimbursement contract.
            ``(cc) An individual who is covered under an employer group 
        health plan that offers coverage through the reasonable cost 
        reimbursement contract.
            ``(dd) An individual who becomes entitled to benefits under 
        part A, or enrolled under part B, and was enrolled in a plan 
        offered by the eligible organization immediately prior to the 
        individual's enrollment under the reasonable cost reimbursement 
        contract.
        ``(III) Not later than a date determined appropriate by the 
    Secretary prior to the beginning of the last reasonable cost 
    reimbursement contract year for the contract, the organization 
    shall provide notice to the Secretary as to whether the 
    organization will apply to have the contract converted over, in 
    whole or in part, and offered as a Medicare Advantage plan under 
    part C for the year following the last reasonable cost 
    reimbursement contract year for the contract.
        ``(IV) If the organization provides the notice described in 
    subclause (III) that the contract will be converted, in whole or in 
    part, the organization shall, not later than a date determined 
    appropriate by the Secretary, provide the Secretary with such 
    information as the Secretary determines appropriate in order to 
    carry out section 1851(c)(4) and to carry out section 1854(a)(5), 
    including subparagraph (C)(ii) of such section.
        ``(V) In the case that the organization enrolls a new enrollee 
    under such contract during the last reasonable cost reimbursement 
    contract year for the contract, the organization shall provide the 
    individual with a notification that such year is the last year for 
    such contract.
    ``(v) If an eligible organization that is offering a reasonable 
cost reimbursement contract that is extended or renewed pursuant to 
clause (iv) provides the notice described in clause (iv)(III) that the 
contract will be converted, in whole or in part, the following shall 
apply:
        ``(I) The deemed enrollment under section 1851(c)(4).
        ``(II) The special rule for quality increase under section 
    1853(o)(4)(C).
        ``(III) During the last reasonable cost reimbursement contract 
    year for the contract and the year immediately preceding such year, 
    the eligible organization, or the corporate parent organization of 
    the eligible organization, shall be permitted to offer an MA plan 
    in the area that such contract is being offered and enroll Medicare 
    Advantage eligible individuals in such MA plan and such cost 
    plan.''.
    (b) Deemed Enrollment From Reasonable Cost Reimbursement Contracts 
Converted to Medicare Advantage Plans.--
        (1) In general.--Section 1851(c) of the Social Security Act (42 
    U.S.C. 1395w-21(c)) is amended--
            (A) in paragraph (1), by striking ``Such elections'' and 
        inserting ``Subject to paragraph (4), such elections''; and
            (B) by adding at the end the following:
        ``(4) Deemed enrollment relating to converted reasonable cost 
    reimbursement contracts.--
            ``(A) In general.--On the first day of the annual, 
        coordinated election period under subsection (e)(3) for plan 
        years beginning on or after January 1, 2017, an MA eligible 
        individual described in clause (i) or (ii) of subparagraph (B) 
        is deemed, unless the individual elects otherwise, to have 
        elected to receive benefits under this title through an 
        applicable MA plan (and shall be enrolled in such plan) 
        beginning with such plan year, if--
                ``(i) the individual is enrolled in a reasonable cost 
            reimbursement contract under section 1876(h) in the 
            previous plan year;
                ``(ii) such reasonable cost reimbursement contract was 
            extended or renewed for the last reasonable cost 
            reimbursement contract year of the contract (as described 
            in subclause (I) of section 1876(h)(5)(C)(iv)) pursuant to 
            such section;
                ``(iii) the eligible organization that is offering such 
            reasonable cost reimbursement contract provided the notice 
            described in subclause (III) of such section that the 
            contract was to be converted;
                ``(iv) the applicable MA plan--

                    ``(I) is the plan that was converted from the 
                reasonable cost reimbursement contract described in 
                clause (iii);
                    ``(II) is offered by the same entity (or an 
                organization affiliated with such entity that has a 
                common ownership interest of control) that entered into 
                such contract; and
                    ``(III) is offered in the service area where the 
                individual resides;

                ``(v) in the case of reasonable cost reimbursement 
            contracts that provide coverage under parts A and B (and, 
            to the extent the Secretary determines it to be feasible, 
            contracts that provide only part B coverage), the 
            difference between the estimated individual costs (as 
            determined applicable by the Secretary) for the applicable 
            MA plan and such costs for the predecessor cost plan does 
            not exceed a threshold established by the Secretary; and
                ``(vi) the applicable MA plan--

                    ``(I) provides coverage for enrollees transitioning 
                from the converted reasonable cost reimbursement 
                contract to such plan to maintain current providers of 
                services and suppliers and course of treatment at the 
                time of enrollment for a period of at least 90 days 
                after enrollment; and
                    ``(II) during such period, pays such providers of 
                services and suppliers for items and services furnished 
                to the enrollee an amount that is not less than the 
                amount of payment applicable for such items and 
                services under the original Medicare fee-for-service 
                program under parts A and B.

            ``(B) MA eligible individuals described.--
                ``(i) Without prescription drug coverage.--An MA 
            eligible individual described in this clause, with respect 
            to a plan year, is an MA eligible individual who is 
            enrolled in a reasonable cost reimbursement contract under 
            section 1876(h) in the previous plan year and who is not, 
            for such previous plan year, enrolled in a prescription 
            drug plan under part D, including coverage under section 
            1860D-22.
                ``(ii) With prescription drug coverage.--An MA eligible 
            individual described in this clause, with respect to a plan 
            year, is an MA eligible individual who is enrolled in a 
            reasonable cost reimbursement contract under section 
            1876(h) in the previous plan year and who, for such 
            previous plan year, is enrolled in a prescription drug plan 
            under part D--

                    ``(I) through such contract; or
                    ``(II) through a prescription drug plan, if the 
                sponsor of such plan is the same entity (or an 
                organization affiliated with such entity) that entered 
                into such contract.

            ``(C) Applicable ma plan defined.--In this paragraph, the 
        term `applicable MA plan' means, in the case of an individual 
        described in--
                ``(i) subparagraph (B)(i), an MA plan that is not an 
            MA-PD plan; and
                ``(ii) subparagraph (B)(ii), an MA-PD plan.
            ``(D) Identification and notification of deemed 
        individuals.--Not later than 45 days before the first day of 
        the annual, coordinated election period under subsection (e)(3) 
        for plan years beginning on or after January 1, 2017, the 
        Secretary shall identify and notify the individuals who will be 
        subject to deemed elections under subparagraph (A) on the first 
        day of such period.''.
        (2) Beneficiary option to discontinue or change ma plan or ma-
    pd plan after deemed enrollment.--
            (A) In general.--Section 1851(e)(2) of the Social Security 
        Act (42 U.S.C. 1395w-21(e)(4)) is amended by adding at the end 
        the following:
            ``(F) Special period for certain deemed elections.--
                ``(i) In general.--At any time during the period 
            beginning after the last day of the annual, coordinated 
            election period under paragraph (3) in which an individual 
            is deemed to have elected to enroll in an MA plan or MA-PD 
            plan under subsection (c)(4) and ending on the last day of 
            February of the first plan year for which the individual is 
            enrolled in such plan, such individual may change the 
            election under subsection (a)(1) (including changing the MA 
            plan or MA-PD plan in which the individual is enrolled).
                ``(ii) Limitation of one change.--An individual may 
            exercise the right under clause (i) only once during the 
            applicable period described in such clause. The limitation 
            under this clause shall not apply to changes in elections 
            effected during an annual, coordinated election period 
            under paragraph (3) or during a special enrollment period 
            under paragraph (4).''.
            (B) Conforming amendments.--
                (i) Plan requirement for open enrollment.--Section 
            1851(e)(6)(A) of the Social Security Act (42 U.S.C. 1395w-
            21(e)(6)(A)) is amended by striking ``paragraph (1),'' and 
            inserting ``paragraph (1), during the period described in 
            paragraph (2)(F),''.
                (ii) Part d.--Section 1860D-1(b)(1)(B) of such Act (42 
            U.S.C. 1395w-101(b)(1)(B)) is amended--

                    (I) in clause (ii), by adding ``and paragraph (4)'' 
                after ``paragraph (3)(A)''; and
                    (II) in clause (iii) by striking ``and (E)'' and 
                inserting ``(E), and (F)''.

        (3) Treatment of esrd for deemed enrollment.--Section 
    1851(a)(3)(B) of the Social Security Act (42 U.S.C. 1395w-
    21(a)(3)(B)) is amended by adding at the end the following flush 
    sentence: ``An individual who develops end-stage renal disease 
    while enrolled in a reasonable cost reimbursement contract under 
    section 1876(h) shall be treated as an MA eligible individual for 
    purposes of applying the deemed enrollment under subsection 
    (c)(4).''.
    (c) Information Requirements.--Section 1851(d)(2)(B) of the Social 
Security Act (42 U.S.C. 1395w-21(d)(2)(B)) is amended--
        (1) in the heading, by striking ``Notification to newly 
    eligible medicare advantage eligible individuals'' and inserting 
    the following: ``Notifications required.--
                ``(i) Notification to newly eligible medicare advantage 
            eligible individuals.--''; and
        (2) by adding at the end the following new clause:
                ``(ii) Notification related to certain deemed 
            elections.--The Secretary shall require a Medicare 
            Advantage organization that is offering a Medicare 
            Advantage plan that has been converted from a reasonable 
            cost reimbursement contract pursuant to section 
            1876(h)(5)(C)(iv) to mail, not later than 30 days prior to 
            the first day of the annual, coordinated election period 
            under subsection (e)(3) of a year, to any individual 
            enrolled under such contract and identified by the 
            Secretary under subsection (c)(4)(D) for such year--

                    ``(I) a notification that such individual will, on 
                such day, be deemed to have made an election with 
                respect to such plan to receive benefits under this 
                title through an MA plan or MA-PD plan (and shall be 
                enrolled in such plan) for the next plan year under 
                subsection (c)(4)(A), but that the individual may make 
                a different election during the annual, coordinated 
                election period for such year;
                    ``(II) the information described in subparagraph 
                (A);
                    ``(III) a description of the differences between 
                such MA plan or MA-PD plan and the reasonable cost 
                reimbursement contract in which the individual was most 
                recently enrolled with respect to benefits covered 
                under such plans, including cost-sharing, premiums, 
                drug coverage, and provider networks;
                    ``(IV) information about the special period for 
                elections under subsection (e)(2)(F); and
                    ``(V) other information the Secretary may 
                specify.''.

    (d) Treatment of Transition Plan for Quality Rating for Payment 
Purposes.--Section 1853(o)(4) of the Social Security Act (42 U.S.C. 
1395w-23(o)(4)) is amended by adding at the end the following new 
subparagraph:
            ``(C) Special rule for first 3 plan years for plans that 
        were converted from a reasonable cost reimbursement contract.--
        For purposes of applying paragraph (1) and section 
        1854(b)(1)(C) for the first 3 plan years under this part in the 
        case of an MA plan to which deemed enrollment applies under 
        section 1851(c)(4)--
                ``(i) such plan shall not be treated as a new MA plan 
            (as defined in paragraph (3)(A)(iii)(II)); and
                ``(ii) in determining the star rating of the plan under 
            subparagraph (A), to the extent that Medicare Advantage 
            data for such plan is not available for a measure used to 
            determine such star rating, the Secretary shall use data 
            from the period in which such plan was a reasonable cost 
            reimbursement contract.''.
    SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON.
    Section 421(a) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283; 42 
U.S.C. 1395fff note), as amended by section 5201(b) of the Deficit 
Reduction Act of 2005 (Public Law 109-171; 120 Stat. 46) and by section 
3131(c) of the Patient Protection and Affordable Care Act (Public Law 
111-148; 124 Stat. 428), is amended by striking ``January 1, 2016'' and 
inserting ``January 1, 2018'' each place it appears.

                   Subtitle B--Other Health Extenders

    SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) 
      PROGRAM.
    (a) Permanent Extension.--Section 1902(a)(10)(E)(iv) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking 
``(but only for premiums payable with respect to months during the 
period beginning with January 1998, and ending with March 2015)''.
    (b) Allocations.--Section 1933(g) of the Social Security Act (42 
U.S.C. 1396u-3(g)) is amended--
        (1) in paragraph (2)--
            (A) by striking subparagraphs (A) through (H);
            (B) in subparagraph (V), by striking ``and'' at the end;
            (C) in subparagraph (W), by striking the period at the end 
        and inserting a semicolon;
            (D) by redesignating subparagraphs (I) through (W) as 
        subparagraphs (A) through (O), respectively; and
            (E) by adding at the end the following new subparagraphs:
            ``(P) for the period that begins on April 1, 2015, and ends 
        on December 31, 2015, the total allocation amount is 
        $535,000,000; and
            ``(Q) for 2016 and, subject to paragraph (4), for each 
        subsequent year, the total allocation amount is 
        $980,000,000.'';
        (2) in paragraph (3), by striking ``(P), (R), (T), or (V)'' and 
    inserting ``or (P)''; and
        (3) by adding at the end the following new paragraph:
        ``(4) Adjustment to allocations.--The Secretary may increase 
    the allocation amount under paragraph (2)(Q) for a year (beginning 
    with 2017) up to an amount that does not exceed the product of the 
    following:
            ``(A) Maximum allocation amount for previous year.--In the 
        case of 2017, the allocation amount for 2016, or in the case of 
        a subsequent year, the maximum allocation amount allowed under 
        this paragraph for the previous year.
            ``(B) Increase in part b premium.--The monthly premium rate 
        determined under section 1839 for the year divided by the 
        monthly premium rate determined under such section for the 
        previous year.
            ``(C) Increase in part b enrollment.--The average number of 
        individuals (as estimated by the Chief Actuary of the Centers 
        for Medicare & Medicaid Services in September of the previous 
        year) to be enrolled under part B of title XVIII for months in 
        the year divided by the average number of such individuals (as 
        so estimated) under this subparagraph with respect to 
        enrollments in months in the previous year.''.
    SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE 
      (TMA).
    (a) In General.--Section 1925 of the Social Security Act (42 U.S.C. 
1396r-6) is amended--
        (1) by striking subsection (f); and
        (2) by redesignating subsection (g) as subsection (f).
    (b) Conforming Amendment.--Section 1902(e)(1) of the Social 
Security Act (42 U.S.C. 1396a(e)(1)) is amended to read as follows:
    ``(1) Beginning April 1, 1990, for provisions relating to the 
extension of eligibility for medical assistance for certain families 
who have received aid pursuant to a State plan approved under part A of 
title IV and have earned income, see section 1925.''.
    SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM FOR TYPE I DIABETES 
      AND FOR INDIANS.
    (a) Special Diabetes Programs for Type I Diabetes.--Section 
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2015'' and inserting ``2017''.
    (b) Special Diabetes Programs for Indians.--Section 330C(c)(2)(C) 
of the Public Health Service Act (42 U.S.C. 254c-3(c)(2)(C)) is amended 
by striking ``2015'' and inserting ``2017''.
    SEC. 214. EXTENSION OF ABSTINENCE EDUCATION.
    (a) In General.--Section 510 of the Social Security Act (42 U.S.C. 
710) is amended--
        (1) in subsection (a), striking ``2015'' and inserting 
    ``2017''; and
        (2) in subsection (d), by inserting ``and an additional 
    $75,000,000 for each of fiscal years 2016 and 2017'' after 
    ``2015''.
    (b) Budget Scoring.--Notwithstanding section 257(b)(2) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, the baseline 
shall be calculated assuming that no grant shall be made under section 
510 of the Social Security Act (42 U.S.C. 710) after fiscal year 2017.
    (c) Reallocation of Unused Funding.--The remaining unobligated 
balances of the amount appropriated for fiscal years 2016 and 2017 by 
section 510(d) of the Social Security Act (42 U.S.C. 710(d)) for which 
no application has been received by the Funding Opportunity 
Announcement deadline, shall be made available to States that require 
the implementation of each element described in subparagraphs (A) 
through (H) of the definition of abstinence education in section 
510(b)(2). The remaining unobligated balances shall be reallocated to 
such States that submit a valid application consistent with the 
original formula for this funding.
    SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM 
      (PREP).
    Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
        (1) in paragraphs (1)(A) and (4)(A) of subsection (a), by 
    striking ``2015'' and inserting ``2017'' each place it appears;
        (2) in subsection (a)(4)(B)(i), by striking ``, 2013, 2014, and 
    2015'' and inserting ``through 2017''; and
        (3) in subsection (f), by striking ``2015'' and inserting 
    ``2017''.
    SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH 
      INFORMATION CENTERS.
     Section 501(c)(1)(A) of the Social Security Act (42 U.S.C. 
701(c)(1)(A)) is amended--
        (1) by striking clause (vi); and
        (2) by adding after clause (v) the following new clause:
        ``(vi) $5,000,000 for each of fiscal years 2015 through 
    2017.''.
    SEC. 217. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECT FOR 
      LOW-INCOME INDIVIDUALS.
    Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ``2015'' and inserting ``2017''.
    SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY CHILDHOOD HOME 
      VISITING PROGRAMS.
    Section 511(j)(1) of the Social Security Act (42 U.S.C. 711(j)) is 
amended--
        (1) by striking ``and'' at the end of subparagraph (E);
        (2) in subparagraph (F)--
            (A) by striking ``for the period beginning on October 1, 
        2014, and ending on March 31, 2015'' and inserting ``for fiscal 
        year 2015'';
            (B) by striking ``an amount equal to the amount provided in 
        subparagraph (E)'' and inserting ``$400,000,000''; and
            (C) by striking the period at the end and inserting a 
        semicolon; and
        (3) by adding at the end the following new subparagraphs:
            ``(G) for fiscal year 2016, $400,000,000; and
            ``(H) for fiscal year 2017, $400,000,000.''.
    SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 2015 THROUGH 
      2025.
    Section 1923(f)(6)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(6)(A)) is amended by adding at the end the following:
                ``(vi) Allotment for fiscal years 2015 through 2025.--
            Notwithstanding any other provision of this subsection, any 
            other provision of law, or the terms of the TennCare 
            Demonstration Project in effect for the State, the DSH 
            allotment for Tennessee for fiscal year 2015, and for each 
            fiscal year thereafter through fiscal year 2025, shall be 
            $53,100,000 for each such fiscal year.''.
    SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID AMENDMENTS RELATING 
      TO BENEFICIARY LIABILITY SETTLEMENTS.
    Section 202(c) of the Bipartisan Budget Act of 2013 (division A of 
Public Law 113-67; 42 U.S.C. 1396a note), as amended by section 211 of 
the Protecting Access to Medicare Act of 2014 (Public Law 113-93; 128 
Stat. 1047) is amended by striking ``October 1, 2016'' and inserting 
``October 1, 2017''.
    SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY HEALTH CENTERS, THE 
      NATIONAL HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS.
    (a) Funding for Community Health Centers and the National Health 
Service Corps.--
        (1) Community health centers.--Section 10503(b)(1)(E) of the 
    Patient Protection and Affordable Care Act (42 U.S.C. 254b-
    2(b)(1)(E)) is amended by striking ``for fiscal year 2015'' and 
    inserting ``for each of fiscal years 2015 through 2017''.
        (2) National health service corps.--Section 10503(b)(2)(E) of 
    the Patient Protection and Affordable Care Act (42 U.S.C. 254b-
    2(b)(2)(E)) is amended by striking ``for fiscal year 2015'' and 
    inserting ``for each of fiscal years 2015 through 2017''.
    (b) Extension of Teaching Health Centers Program.--Section 340H(g) 
of the Public Health Service Act (42 U.S.C. 256h(g)) is amended by 
inserting ``and $60,000,000 for each of fiscal years 2016 and 2017'' 
before the period at the end.
    (c) Application.--Amounts appropriated pursuant to this section for 
fiscal year 2016 and fiscal year 2017 are subject to the requirements 
contained in Public Law 113-235 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act (42 U.S.C. 
254b-256).

                            TITLE III--CHIP

    SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN'S HEALTH INSURANCE 
      PROGRAM.
    (a) Funding.--Section 2104(a) of the Social Security Act (42 U.S.C. 
1397dd(a)) is amended--
        (1) in paragraph (17), by striking ``and'' at the end;
        (2) in paragraph (18)(B), by striking the period at the end and 
    inserting a semicolon; and
        (3) by adding at the end the following new paragraphs:
        ``(19) for fiscal year 2016, $19,300,000,000; and
        ``(20) for fiscal year 2017, for purposes of making 2 semi-
    annual allotments--
            ``(A) $2,850,000,000 for the period beginning on October 1, 
        2016, and ending on March 31, 2017; and
            ``(B) $2,850,000,000 for the period beginning on April 1, 
        2017, and ending on September 30, 2017.''.
    (b) Allotments.--
        (1) In general.--Section 2104(m) of the Social Security Act (42 
    U.S.C. 1397dd(m)) is amended--
            (A) in the subsection heading, by striking ``Through 2015'' 
        and inserting ``and Thereafter'';
            (B) in paragraph (2)--
                (i) in the paragraph heading, by striking ``2014'' and 
            inserting ``2016''; and
                (ii) by striking subparagraph (B) and inserting the 
            following new subparagraph:
            ``(B) Fiscal year 2013 and each succeeding fiscal year.--
        Subject to paragraphs (5) and (7), from the amount made 
        available under paragraphs (16) through (19) of subsection (a) 
        for fiscal year 2013 and each succeeding fiscal year, 
        respectively, the Secretary shall compute a State allotment for 
        each State (including the District of Columbia and each 
        commonwealth and territory) for each such fiscal year as 
        follows:
                ``(i) Rebasing in fiscal year 2013 and each succeeding 
            odd-numbered fiscal year.--For fiscal year 2013 and each 
            succeeding odd-numbered fiscal year (other than fiscal 
            years 2015 and 2017), the allotment of the State is equal 
            to the Federal payments to the State that are attributable 
            to (and countable toward) the total amount of allotments 
            available under this section to the State in the preceding 
            fiscal year (including payments made to the State under 
            subsection (n) for such preceding fiscal year as well as 
            amounts redistributed to the State in such preceding fiscal 
            year), multiplied by the allotment increase factor under 
            paragraph (6) for such odd-numbered fiscal year.
                ``(ii) Growth factor update for fiscal year 2014 and 
            each succeeding even-numbered fiscal year.--Except as 
            provided in clauses (iii) and (iv), for fiscal year 2014 
            and each succeeding even-numbered fiscal year, the 
            allotment of the State is equal to the sum of--

                    ``(I) the amount of the State allotment under 
                clause (i) for the preceding fiscal year; and
                    ``(II) the amount of any payments made to the State 
                under subsection (n) for such preceding fiscal year,

            multiplied by the allotment increase factor under paragraph 
            (6) for such even-numbered fiscal year.
                ``(iii) Special rule for 2016.--For fiscal year 2016, 
            the allotment of the State is equal to the Federal payments 
            to the State that are attributable to (and countable 
            toward) the total amount of allotments available under this 
            section to the State in the preceding fiscal year 
            (including payments made to the State under subsection (n) 
            for such preceding fiscal year as well as amounts 
            redistributed to the State in such preceding fiscal year), 
            but determined as if the last two sentences of section 
            2105(b) were in effect in such preceding fiscal year and 
            then multiplying the result by the allotment increase 
            factor under paragraph (6) for fiscal year 2016.
                ``(iv) Reduction in 2018.--For fiscal year 2018, with 
            respect to the allotment of the State for fiscal year 2017, 
            any amounts of such allotment that remain available for 
            expenditure by the State in fiscal year 2018 shall be 
            reduced by one-third.'';
            (C) in paragraph (4), by inserting ``or 2017'' after 
        ``2015'';
            (D) in paragraph (6)--
                (i) in subparagraph (A), by striking ``2015'' and 
            inserting ``2017''; and
                (ii) in the second sentence, by striking ``or fiscal 
            year 2014'' and inserting ``fiscal year 2014, or fiscal 
            year 2016'';
            (E) in paragraph (8)--
                (i) in the paragraph heading, by striking ``fiscal year 
            2015'' and inserting ``fiscal years 2015 and 2017''; and
                (ii) by inserting ``or fiscal year 2017'' after 
            ``2015'';
            (F) by redesignating paragraphs (4) through (8) as 
        paragraphs (5) through (9), respectively; and
            (G) by inserting after paragraph (3) the following new 
        paragraph:
        ``(4) For fiscal year 2017.--
            ``(A) First half.--Subject to paragraphs (5) and (7), from 
        the amount made available under subparagraph (A) of paragraph 
        (20) of subsection (a) for the semi-annual period described in 
        such paragraph, increased by the amount of the appropriation 
        for such period under section 301(b)(3) of the Medicare Access 
        and CHIP Reauthorization Act of 2015, the Secretary shall 
        compute a State allotment for each State (including the 
        District of Columbia and each commonwealth and territory) for 
        such semi-annual period in an amount equal to the first half 
        ratio (described in subparagraph (D)) of the amount described 
        in subparagraph (C).
            ``(B) Second half.--Subject to paragraphs (5) and (7), from 
        the amount made available under subparagraph (B) of paragraph 
        (20) of subsection (a) for the semi-annual period described in 
        such paragraph, the Secretary shall compute a State allotment 
        for each State (including the District of Columbia and each 
        commonwealth and territory) for such semi-annual period in an 
        amount equal to the amount made available under such 
        subparagraph, multiplied by the ratio of--
                ``(i) the amount of the allotment to such State under 
            subparagraph (A); to
                ``(ii) the total of the amount of all of the allotments 
            made available under such subparagraph.
            ``(C) Full year amount based on rebased amount.--The amount 
        described in this subparagraph for a State is equal to the 
        Federal payments to the State that are attributable to (and 
        countable towards) the total amount of allotments available 
        under this section to the State in fiscal year 2016 (including 
        payments made to the State under subsection (n) for fiscal year 
        2016 as well as amounts redistributed to the State in fiscal 
        year 2016), multiplied by the allotment increase factor under 
        paragraph (6) for fiscal year 2017.
            ``(D) First half ratio.--The first half ratio described in 
        this subparagraph is the ratio of--
                ``(i) the sum of--

                    ``(I) the amount made available under subsection 
                (a)(20)(A); and
                    ``(II) the amount of the appropriation for such 
                period under section 301(b)(3) of the Medicare Access 
                and CHIP Reauthorization Act of 2015; to

                ``(ii) the sum of the--

                    ``(I) amount described in clause (i); and
                    ``(II) the amount made available under subsection 
                (a)(20)(B).''.

        (2) Conforming amendments.--
            (A) Section 2104(c)(1) of the Social Security Act (42 
        U.S.C. 1397dd(c)(1)) is amended by striking ``(m)(4)'' and 
        inserting ``(m)(5)''.
            (B) Section 2104(m) of such Act (42 U.S.C. 1397dd(m)), as 
        amended by paragraph (1), is further amended--
                (i) in paragraph (1)--

                    (I) by striking ``paragraph (4)'' each place it 
                appears in subparagraphs (A) and (B) and inserting 
                ``paragraph (5)''; and
                    (II) by striking ``the allotment increase factor 
                determined under paragraph (5)'' each place it appears 
                and inserting ``the allotment increase factor 
                determined under paragraph (6)'';

                (ii) in paragraph (2)(A), by striking ``the allotment 
            increase factor under paragraph (5)'' and inserting ``the 
            allotment increase factor under paragraph (6)'';
                (iii) in paragraph (3)--

                    (I) by striking ``paragraphs (4) and (6)'' and 
                inserting ``paragraphs (5) and (7)'' each place it 
                appears; and
                    (II) by striking ``the allotment increase factor 
                under paragraph (5)'' and inserting ``the allotment 
                increase factor under paragraph (6)'';

                (iv) in paragraph (5) (as redesignated by paragraph 
            (1)(F)), by striking ``paragraph (1), (2), or (3)'' and 
            inserting ``paragraph (1), (2), (3), or (4)'';
                (v) in paragraph (7) (as redesignated by paragraph 
            (1)(F)), by striking ``subject to paragraph (4)'' and 
            inserting ``subject to paragraph (5)''; and
                (vi) in paragraph (9), (as redesignated by paragraph 
            (1)(F)), by striking ``paragraph (3)'' and inserting 
            ``paragraph (3) or (4)''.
            (C) Section 2104(n)(3)(B)(ii) of such Act (42 U.S.C. 
        1397dd(n)(3)(B)(ii)) is amended by striking ``subsection 
        (m)(5)(B)'' and inserting ``subsection (m)(6)(B)''.
            (D) Section 2111(b)(2)(B)(i) of such Act (42 U.S.C. 
        1397kk(b)(2)(B)(i)) is amended by striking ``section 
        2104(m)(4)'' and inserting ``section 2104(m)(5)''.
        (3) One-time appropriation for fiscal year 2017.--There is 
    appropriated to the Secretary of Health and Human Services, out of 
    any money in the Treasury not otherwise appropriated, 
    $14,700,000,000 to accompany the allotment made for the period 
    beginning on October 1, 2016, and ending on March 31, 2017, under 
    paragraph (20)(A) of section 2104(a) of the Social Security Act (42 
    U.S.C. 1397dd(a)) (as added by subsection (a)(1)), to remain 
    available until expended. Such amount shall be used to provide 
    allotments to States under paragraph (4) of section 2104(m) of such 
    Act (42 U.S.C. 1397dd(m)) (as amended by paragraph(1)(G)) for the 
    first 6 months of fiscal year 2017 in the same manner as allotments 
    are provided under subsection (a)(20)(A) of such section 2104 and 
    subject to the same terms and conditions as apply to the allotments 
    provided from such subsection (a)(20)(A).
    (c) Extension of Qualifying States Option.--Section 2105(g)(4) of 
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
        (1) in the paragraph heading, by striking ``2015'' and 
    inserting ``2017''; and
        (2) in subparagraph (A), by striking ``2015'' and inserting 
    ``2017''.
    (d) Extension of the Child Enrollment Contingency Fund.--
        (1) In general.--Section 2104(n) of the Social Security Act (42 
    U.S.C. 1397dd(n)) is amended--
            (A) in paragraph (2)--
                (i) in subparagraph (A)(ii)--

                    (I) by striking ``2010 through 2014'' and inserting 
                ``2010, 2011, 2012, 2013, 2014, and 2016''; and
                    (II) by inserting ``and fiscal year 2017'' after 
                ``2015''; and

                (ii) in subparagraph (B)--

                    (I) by striking ``2010 through 2014'' and inserting 
                ``2010, 2011, 2012, 2013, 2014, and 2016''; and
                    (II) by inserting ``and fiscal year 2017'' after 
                ``2015''; and

            (B) in paragraph (3)(A), in the matter preceding clause 
        (i), by striking ``fiscal year 2009, fiscal year 2010, fiscal 
        year 2011, fiscal year 2012, fiscal year 2013, fiscal year 
        2014, or a semi-annual allotment period for fiscal year 2015'' 
        and inserting ``any of fiscal years 2009 through 2014, fiscal 
        year 2016, or a semi-annual allotment period for fiscal year 
        2015 or 2017''.
    SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY.
    Section 1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
1396a(e)(13)(I)) is amended by striking ``2015'' and inserting 
``2017''.
    SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
    Section 2113 of the Social Security Act (42 U.S.C. 1397mm) is 
amended--
        (1) in subsection (a)(1), by striking ``2015'' and inserting 
    ``2017''; and
        (2) in subsection (g), by inserting ``and $40,000,000 for the 
    period of fiscal years 2016 and 2017'' after ``2015''.
    SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION PROJECTS.
    (a) Childhood Obesity Demonstration Project.--Section 1139A(e)(8) 
of the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended by 
inserting ``, and $10,000,000 for the period of fiscal years 2016 and 
2017'' after ``2014''.
    (b) Pediatric Quality Measures Program.--Section 1139A(i) of the 
Social Security Act (42 U.S.C. 1320b-9a(i)) is amended in the first 
sentence by inserting before the period at the end the following: ``, 
and there is appropriated for the period of fiscal years 2016 and 2017, 
$20,000,000 for the purpose of carrying out this section (other than 
subsections (e), (f), and (g))''.
    SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON USE OF EXPRESS LANE 
      OPTION UNDER MEDICAID AND CHIP.
    Not later than 18 months after the date of the enactment of this 
Act, the Inspector General of the Department of Health and Human 
Services shall submit to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Finance of the Senate a 
report that--
        (1) provides data on the number of individuals enrolled in the 
    Medicaid program under title XIX of the Social Security Act 
    (referred to in this section as ``Medicaid'') and the Children's 
    Health Insurance Program under title XXI of such Act (referred to 
    in this section as ``CHIP'') through the use of the Express Lane 
    option under section 1902(e)(13) of the Social Security Act (42 
    U.S.C. 1396a(e)(13));
        (2) assesses the extent to which individuals so enrolled meet 
    the eligibility requirements under Medicaid or CHIP (as 
    applicable); and
        (3) provides data on Federal and State expenditures under 
    Medicaid and CHIP for individuals so enrolled and disaggregates 
    such data between expenditures made for individuals who meet the 
    eligibility requirements under Medicaid or CHIP (as applicable) and 
    expenditures made for individuals who do not meet such 
    requirements.

                           TITLE IV--OFFSETS
                Subtitle A--Medicare Beneficiary Reforms

    SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES FOR NEWLY ELIGIBLE 
      MEDICARE BENEFICIARIES.
    Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is 
amended by adding at the end the following new subsection:
    ``(z) Limitation on Certain Medigap Policies for Newly Eligible 
Medicare Beneficiaries.--
        ``(1) In general.--Notwithstanding any other provision of this 
    section, on or after January 1, 2020, a medicare supplemental 
    policy that provides coverage of the part B deductible, including 
    any such policy (or rider to such a policy) issued under a waiver 
    granted under subsection (p)(6), may not be sold or issued to a 
    newly eligible Medicare beneficiary.
        ``(2) Newly eligible medicare beneficiary defined.--In this 
    subsection, the term `newly eligible Medicare beneficiary' means an 
    individual who is neither of the following:
            ``(A) An individual who has attained age 65 before January 
        1, 2020.
            ``(B) An individual who was entitled to benefits under part 
        A pursuant to section 226(b) or 226A, or deemed to be eligible 
        for benefits under section 226(a), before January 1, 2020.
        ``(3) Treatment of waivered states.--In the case of a State 
    described in subsection (p)(6), nothing in this section shall be 
    construed as preventing the State from modifying its alternative 
    simplification program under such subsection so as to eliminate the 
    coverage of the part B deductible for any medical supplemental 
    policy sold or issued under such program to a newly eligible 
    Medicare beneficiary on or after January 1, 2020.
        ``(4) Treatment of references to certain policies.--In the case 
    of a newly eligible Medicare beneficiary, except as the Secretary 
    may otherwise provide, any reference in this section to a medicare 
    supplemental policy which has a benefit package classified as `C' 
    or `F' shall be deemed, as of January 1, 2020, to be a reference to 
    a medicare supplemental policy which has a benefit package 
    classified as `D' or `G', respectively.
        ``(5) Enforcement.--The penalties described in clause (ii) of 
    subsection (d)(3)(A) shall apply with respect to a violation of 
    paragraph (1) in the same manner as it applies to a violation of 
    clause (i) of such subsection.''.
    SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR PARTS B AND D.
    (a) In General.--Section 1839(i)(3)(C)(i) of the Social Security 
Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended--
        (1) by inserting after ``In general.--'' the following:

                    ``(I) Subject to paragraphs (5) and (6), for years 
                before 2018:''; and

        (2) by adding at the end the following:

                    ``(II) Subject to paragraph (5), for years 
                beginning with 2018:

``If the modified adjusted gross income is:              The applicable
                                                                  percentage is:
  More than $85,000 but not more than $107,000.....            35 percent
  More than $107,000 but not more than $133,500....            50 percent
  More than $133,500 but not more than $160,000....            65 percent
  More than $160,000...............................            80 percent.''.
 

''.    (b) Conforming Amendments.--Section 1839(i) of the Social 
Security Act (42 U.S.C. 1395r(i)) is amended--
        (1) in paragraph (2)(A), by inserting ``(or, beginning with 
    2018, $85,000)'' after ``$80,000'';
        (2) in paragraph (3)(A)(i), by inserting ``applicable'' before 
    ``table'';
        (3) in paragraph (5)(A)--
            (A) in the matter before clause (i), by inserting ``(other 
        than 2018 and 2019)'' after ``2007''; and
            (B) in clause (ii), by inserting ``(or, in the case of a 
        calendar year beginning with 2020, August 2018)'' after 
        ``August 2006''; and
        (4) in paragraph (6), in the matter before subparagraph (A), by 
    striking ``2019'' and inserting ``2017''.

                       Subtitle B--Other Offsets

    SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE PROVIDERS.
    (a) SNFs.--Section 1888(e) of the Social Security Act (42 U.S.C. 
1395yy(e))--
        (1) in paragraph (5)(B)--
            (A) in clause (i), by striking ``clause (ii)'' and 
        inserting ``clauses (ii) and (iii)'';
            (B) in clause (ii), by inserting ``subject to clause 
        (iii),'' after ``each subsequent fiscal year,''; and
            (C) by adding at the end the following new clause:
                ``(iii) Special rule for fiscal year 2018.--For fiscal 
            year 2018 (or other similar annual period specified in 
            clause (i)), the skilled nursing facility market basket 
            percentage, after application of clause (ii), is equal to 1 
            percent.''; and
        (2) in paragraph (6)(A), by striking ``paragraph (5)(B)(ii)'' 
    and inserting ``clauses (ii) and (iii) of paragraph (5)(B)'' each 
    place it appears.
    (b) IRFs.--Section 1886(j) of the Social Security Act (42 U.S.C. 
1395ww(j)) is amended--
        (1) in paragraph (3)(C)--
            (A) in clause (i), by striking ``clause (ii)'' and 
        inserting ``clauses (ii) and (iii)'';
            (B) in clause (ii), by striking ``After'' and inserting 
        ``Subject to clause (iii), after''; and
            (C) by adding at the end the following new clause:
                ``(iii) Special rule for fiscal year 2018.--The 
            increase factor to be applied under this subparagraph for 
            fiscal year 2018, after the application of clause (ii), 
            shall be 1 percent.''; and
        (2) in paragraph (7)(A)(i), by striking ``paragraph (3)(D)'' 
    and inserting ``subparagraphs (C)(iii) and (D) of paragraph (3)''.
    (c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)) is amended--
        (1) in clause (iii), by adding at the end the following: 
    ``Notwithstanding the previous sentence, the home health market 
    basket percentage increase for 2018 shall be 1 percent.''; and
        (2) in clause (vi)(I), by inserting ``(except 2018)'' after 
    ``each subsequent year''.
    (d) Hospice.--Section 1814(i) of the Social Security Act (42 U.S.C. 
1395f(i)) is amended--
        (1) in paragraph (1)(C)--
            (A) in clause (ii)(VII), by striking ``clause (iv),,'' and 
        inserting ``clauses (iv) and (vi),'';
            (B) in clause (iii), by striking ``clause (iv),'' and 
        inserting ``clauses (iv) and (vi),'';
            (C) in clause (iv), by striking ``After determining'' and 
        inserting ``Subject to clause (vi), after determining''; and
            (D) by adding at the end the following new clause:
    ``(vi) For fiscal year 2018, the market basket percentage increase 
under clause (ii)(VII) or (iii), as applicable, after application of 
clause (iv), shall be 1 percent.''; and
        (2) in paragraph (5)(A)(i), by striking ``paragraph 
    (1)(C)(iv)'' and inserting ``clauses (iv) and (vi) of paragraph 
    (1)(C)''.
    (e) LTCHs.--Section 1886(m)(3) of the Social Security Act (42 
U.S.C. 1395ww(m)(3)) is amended--
        (1) in subparagraph (A), in the matter preceding clause (i), by 
    striking ``In implementing'' and inserting ``Subject to 
    subparagraph (C), in implementing''; and
        (2) by adding at the end the following new subparagraph:
            ``(C) Additional special rule.--For fiscal year 2018, the 
        annual update under subparagraph (A) for the fiscal year, after 
        application of clauses (i) and (ii) of subparagraph (A), shall 
        be 1 percent.''.
    SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.
    Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) 
is amended--
        (1) in paragraph (7)(A)--
            (A) in clause (i), by striking ``2017 through 2024'' and 
        inserting ``2018 through 2025'';
            (B) by striking clause (ii) and inserting the following new 
        clause:
                ``(ii) Aggregate reductions.--The aggregate reductions 
            in DSH allotments for all States under clause (i)(I) shall 
            be equal to--

                    ``(I) $2,000,000,000 for fiscal year 2018;
                    ``(II) $3,000,000,000 for fiscal year 2019;
                    ``(III) $4,000,000,000 for fiscal year 2020;
                    ``(IV) $5,000,000,000 for fiscal year 2021;
                    ``(V) $6,000,000,000 for fiscal year 2022;
                    ``(VI) $7,000,000,000 for fiscal year 2023;
                    ``(VII) $8,000,000,000 for fiscal year 2024; and
                    ``(VIII) $8,000,000,000 for fiscal year 2025.''; 
                and

            (C) by adding at the end the following new clause:
                ``(v) Distribution of aggregate reductions.--The 
            Secretary shall distribute the aggregate reductions under 
            clause (ii) among States in accordance with subparagraph 
            (B).''; and
        (2) in paragraph (8), by striking ``2024'' and inserting 
    ``2025''.
    SEC. 413. LEVY ON DELINQUENT PROVIDERS.
    (a) In General.--Paragraph (3) of section 6331(h) of the Internal 
Revenue Code of 1986 is amended by striking ``30 percent'' and 
inserting ``100 percent''.
    (b) Effective Date.--The amendment made by this section shall apply 
to payments made after 180 days after the date of the enactment of this 
Act.
    SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAYMENT RATES.
    Section 7(b) of the TMA, Abstinence Education, and QI Programs 
Extension Act of 2007 (Public Law 110-90), as amended by section 631(b) 
of the American Taxpayer Relief Act of 2012 (Public Law 112-240), is 
amended--
        (1) in paragraph (1)--
            (A) in the matter preceding subparagraph (A), by striking 
        ``, 2009, or 2010'' and inserting ``or 2009''; and
            (B) in subparagraph (B)--
                (i) in clause (i), by striking ``and'' at the end;
                (ii) in clause (ii), by striking the period at the end 
            and inserting ``; and''; and
                (iii) by adding at the end the following new clause:
            ``(iii) make an additional adjustment to the standardized 
        amounts under such section 1886(d) of an increase of 0.5 
        percentage points for discharges occurring during each of 
        fiscal years 2018 through 2023 and not make the adjustment 
        (estimated to be an increase of 3.2 percent) that would 
        otherwise apply for discharges occurring during fiscal year 
        2018 by reason of the completion of the adjustments required 
        under clause (ii).'';
        (2) in paragraph (3)--
            (A) by striking ``shall be construed'' and all that follows 
        through ``providing authority'' and inserting ``shall be 
        construed as providing authority''; and
            (B) by inserting ``and each succeeding fiscal year through 
        fiscal year 2023'' after ``2017'';
        (3) by redesignating paragraphs (3) and (4) as paragraphs (4) 
    and (5), respectively; and
        (4) by inserting after paragraph (2) the following new 
    paragraph:
        ``(3) Prohibition.--The Secretary shall not make an additional 
    prospective adjustment (estimated to be a decrease of 0.55 percent) 
    to the standardized amounts under such section 1886(d) to offset 
    the amount of the increase in aggregate payments related to 
    documentation and coding changes for discharges occurring during 
    fiscal year 2010.''.

                         TITLE V--MISCELLANEOUS
            Subtitle A--Protecting the Integrity of Medicare

    SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECURITY ACCOUNT 
      NUMBERS ON MEDICARE CARDS.
    (a) In General.--Section 205(c)(2)(C) of the Social Security Act 
(42 U.S.C. 405(c)(2)(C)) is amended--
        (1) by moving clause (x), as added by section 1414(a)(2) of the 
    Patient Protection and Affordable Care Act, 6 ems to the left;
        (2) by redesignating clause (x), as added by section 2(a)(1) of 
    the Social Security Number Protection Act of 2010, and clause (xi) 
    as clauses (xi) and (xii), respectively; and
        (3) by adding at the end the following new clause:
    ``(xiii) The Secretary of Health and Human Services, in 
consultation with the Commissioner of Social Security, shall establish 
cost-effective procedures to ensure that a Social Security account 
number (or derivative thereof) is not displayed, coded, or embedded on 
the Medicare card issued to an individual who is entitled to benefits 
under part A of title XVIII or enrolled under part B of title XVIII and 
that any other identifier displayed on such card is not identifiable as 
a Social Security account number (or derivative thereof).''.
    (b) Implementation.--In implementing clause (xiii) of section 
205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)), as 
added by subsection (a)(3), the Secretary of Health and Human Services 
shall do the following:
        (1) In general.--Establish a cost-effective process that 
    involves the least amount of disruption to, as well as necessary 
    assistance for, Medicare beneficiaries and health care providers, 
    such as a process that provides such beneficiaries with access to 
    assistance through a toll-free telephone number and provides 
    outreach to providers.
        (2) Consideration of medicare beneficiary identified.--Consider 
    implementing a process, similar to the process involving Railroad 
    Retirement Board beneficiaries, under which a Medicare beneficiary 
    identifier which is not a Social Security account number (or 
    derivative thereof) is used external to the Department of Health 
    and Human Services and is convertible over to a Social Security 
    account number (or derivative thereof) for use internal to such 
    Department and the Social Security Administration.
    (c) Funding for Implementation.--For purposes of implementing the 
provisions of and the amendments made by this section, the Secretary of 
Health and Human Services shall provide for the following transfers 
from the Federal Hospital Insurance Trust Fund under section 1817 of 
the Social Security Act (42 U.S.C. 1395i) and from the Federal 
Supplementary Medical Insurance Trust Fund established under section 
1841 of such Act (42 U.S.C. 1395t), in such proportions as the 
Secretary determines appropriate:
        (1) To the Centers for Medicare & Medicaid Program Management 
    Account, transfers of the following amounts:
            (A) For fiscal year 2015, $65,000,000, to be made available 
        through fiscal year 2018.
            (B) For each of fiscal years 2016 and 2017, $53,000,000, to 
        be made available through fiscal year 2018.
            (C) For fiscal year 2018, $48,000,000, to be made available 
        until expended.
        (2) To the Social Security Administration Limitation on 
    Administration Account, transfers of the following amounts:
            (A) For fiscal year 2015, $27,000,000, to be made available 
        through fiscal year 2018.
            (B) For each of fiscal years 2016 and 2017, $22,000,000, to 
        be made available through fiscal year 2018.
            (C) For fiscal year 2018, $27,000,000, to be made available 
        until expended.
        (3) To the Railroad Retirement Board Limitation on 
    Administration Account, the following amount:
            (A) For fiscal year 2015, $3,000,000, to be made available 
        until expended.
    (d) Effective Date.--
        (1) In general.--Clause (xiii) of section 205(c)(2)(C) of the 
    Social Security Act (42 U.S.C. 405(c)(2)(C)), as added by 
    subsection (a)(3), shall apply with respect to Medicare cards 
    issued on and after an effective date specified by the Secretary of 
    Health and Human Services, but in no case shall such effective date 
    be later than the date that is four years after the date of the 
    enactment of this Act.
        (2) Reissuance.--The Secretary shall provide for the reissuance 
    of Medicare cards that comply with the requirements of such clause 
    not later than four years after the effective date specified by the 
    Secretary under paragraph (1).
    SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS FOR ITEMS AND 
      SERVICES FURNISHED TO INCARCERATED INDIVIDUALS, INDIVIDUALS NOT 
      LAWFULLY PRESENT, AND DECEASED INDIVIDUALS.
    (a) Requirement for the Secretary To Establish Policies and Claims 
Edits Relating to Incarcerated Individuals, Individuals Not Lawfully 
Present, and Deceased Individuals.--Section 1874 of the Social Security 
Act (42 U.S.C. 1395kk) is amended by adding at the end the following 
new subsection:
    ``(f) Requirement for the Secretary To Establish Policies and 
Claims Edits Relating to Incarcerated Individuals, Individuals Not 
Lawfully Present, and Deceased Individuals.--The Secretary shall 
establish and maintain procedures, including procedures for using 
claims processing edits, updating eligibility information to improve 
provider accessibility, and conducting recoupment activities such as 
through recovery audit contractors, in order to ensure that payment is 
not made under this title for items and services furnished to an 
individual who is one of the following:
        ``(1) An individual who is incarcerated.
        ``(2) An individual who is not lawfully present in the United 
    States and who is not eligible for coverage under this title.
        ``(3) A deceased individual.''.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this section, and periodically thereafter as determined 
necessary by the Office of Inspector General of the Department of 
Health and Human Services, such Office shall submit to Congress a 
report on the activities described in subsection (f) of section 1874 of 
the Social Security Act (42 U.S.C. 1395kk), as added by subsection (a), 
that have been conducted since such date of enactment.
    SEC. 503. CONSIDERATION OF MEASURES REGARDING MEDICARE BENEFICIARY 
      SMART CARDS.
    To the extent the Secretary of Health and Human Services determines 
that it is cost effective and technologically viable to use electronic 
Medicare beneficiary and provider cards (such as cards that use smart 
card technology, including an embedded and secure integrated circuit 
chip), as presented in the Government Accountability Office report 
required by the conference report accompanying the Consolidated 
Appropriations Act, 2014 (Public Law 113-76), the Secretary shall 
consider such measures as determined appropriate by the Secretary to 
implement such use of such cards for beneficiary and provider use under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). In the 
case that the Secretary considers measures under the preceding 
sentence, the Secretary shall submit to the Committees on Ways and 
Means and Energy and Commerce of the House of Representatives, and to 
the Committee on Finance of the Senate, a report outlining the 
considerations undertaken by the Secretary under such sentence.
    SEC. 504. MODIFYING MEDICARE DURABLE MEDICAL EQUIPMENT FACE-TO-FACE 
      ENCOUNTER DOCUMENTATION REQUIREMENT.
    (a) In General.--Section 1834(a)(11)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is amended--
        (1) by striking ``the physician documenting that''; and
        (2) by striking ``has had a face-to-face encounter'' and 
    inserting ``documenting such physician, physician assistant, 
    practitioner, or specialist has had a face-to-face encounter''.
    (b) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the amendments 
made by subsection (a) by program instruction or otherwise.
    SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS.
    (a) Medicare Administrative Contractor Improper Payment Outreach 
and Education Program.--Section 1874A of the Social Security Act (42 
U.S.C. 1395kk-1) is amended--
        (1) in subsection (a)(4)--
            (A) by redesignating subparagraph (G) as subparagraph (H); 
        and
            (B) by inserting after subparagraph (F) the following new 
        subparagraph:
            ``(G) Improper payment outreach and education program.--
        Having in place an improper payment outreach and education 
        program described in subsection (h).''; and
        (2) by adding at the end the following new subsection:
    ``(h) Improper Payment Outreach and Education Program.--
        ``(1) In general.--In order to reduce improper payments under 
    this title, each medicare administrative contractor shall establish 
    and have in place an improper payment outreach and education 
    program under which the contractor, through outreach, education, 
    training, and technical assistance or other activities, shall 
    provide providers of services and suppliers located in the region 
    covered by the contract under this section with the information 
    described in paragraph (2). The activities described in the 
    preceding sentence shall be conducted on a regular basis.
        ``(2) Information to be provided through activities.--The 
    information to be provided under such payment outreach and 
    education program shall include information the Secretary 
    determines to be appropriate, which may include the following 
    information:
            ``(A) A list of the providers' or suppliers' most frequent 
        and expensive payment errors over the last quarter.
            ``(B) Specific instructions regarding how to correct or 
        avoid such errors in the future.
            ``(C) A notice of new topics that have been approved by the 
        Secretary for audits conducted by recovery audit contractors 
        under section 1893(h).
            ``(D) Specific instructions to prevent future issues 
        related to such new audits.
            ``(E) Other information determined appropriate by the 
        Secretary.
        ``(3) Priority.--A medicare administrative contractor shall 
    give priority to activities under such program that will reduce 
    improper payments that are one or more of the following:
            ``(A) Are for items and services that have the highest rate 
        of improper payment.
            ``(B) Are for items and service that have the greatest 
        total dollar amount of improper payments.
            ``(C) Are due to clear misapplication or misinterpretation 
        of Medicare policies.
            ``(D) Are clearly due to common and inadvertent clerical or 
        administrative errors.
            ``(E) Are due to other types of errors that the Secretary 
        determines could be prevented through activities under the 
        program.
        ``(4) Information on improper payments from recovery audit 
    contractors.--
            ``(A) In general.--In order to assist medicare 
        administrative contractors in carrying out improper payment 
        outreach and education programs, the Secretary shall provide 
        each contractor with a complete list of the types of improper 
        payments identified by recovery audit contractors under section 
        1893(h) with respect to providers of services and suppliers 
        located in the region covered by the contract under this 
        section. Such information shall be provided on a time frame the 
        Secretary determines appropriate which may be on a quarterly 
        basis.
            ``(B) Information.--The information described in 
        subparagraph (A) shall include information such as the 
        following:
                ``(i) Providers of services and suppliers that have the 
            highest rate of improper payments.
                ``(ii) Providers of services and suppliers that have 
            the greatest total dollar amounts of improper payments.
                ``(iii) Items and services furnished in the region that 
            have the highest rates of improper payments.
                ``(iv) Items and services furnished in the region that 
            are responsible for the greatest total dollar amount of 
            improper payments.
                ``(v) Other information the Secretary determines would 
            assist the contractor in carrying out the program.
        ``(5) Communications.--Communications with providers of 
    services and suppliers under an improper payment outreach and 
    education program are subject to the standards and requirements of 
    subsection (g).''.
    (b) Use of Certain Funds Recovered by RACs.--Section 1893(h) of the 
Social Security Act (42 U.S.C. 1395ddd(h)) is amended--
        (1) in paragraph (2), by inserting ``or paragraph (10)'' after 
    ``paragraph (1)(C)''; and
        (2) by adding at the end the following new paragraph:
        ``(10) Use of certain recovered funds.--
            ``(A) In general.--After application of paragraph (1)(C), 
        the Secretary shall retain a portion of the amounts recovered 
        by recovery audit contractors for each year under this section 
        which shall be available to the program management account of 
        the Centers for Medicare & Medicaid Services for purposes of, 
        subject to subparagraph (B), carrying out sections 1833(z), 
        1834(l)(16), and 1874A(a)(4)(G), carrying out section 514(b) of 
        the Medicare Access and CHIP Reauthorization Act of 2015, and 
        implementing strategies (such as claims processing edits) to 
        help reduce the error rate of payments under this title. The 
        amounts retained under the preceding sentence shall not exceed 
        an amount equal to 15 percent of the amounts recovered under 
        this subsection, and shall remain available until expended.
            ``(B) Limitation.--Except for uses that support claims 
        processing (including edits) or system functionality for 
        detecting fraud, amounts retained under subparagraph (A) may 
        not be used for technological-related infrastructure, capital 
        investments, or information systems.
            ``(C) No reduction in payments to recovery audit 
        contractors.--Nothing in subparagraph (A) shall reduce amounts 
        available for payments to recovery audit contractors under this 
        subsection.''.
    SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND FRAUD REPORTING 
      REWARDS.
    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall develop a plan to 
revise the incentive program under section 203(b) of the Health 
Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1395b-
5(b)) to encourage greater participation by individuals to report fraud 
and abuse in the Medicare program. Such plan shall include 
recommendations for--
        (1) ways to enhance rewards for individuals reporting under the 
    incentive program, including rewards based on information that 
    leads to an administrative action; and
        (2) extending the incentive program to the Medicaid program.
    (b) Public Awareness and Education Campaign.--The plan developed 
under subsection (a) shall also include recommendations for the use of 
the Senior Medicare Patrols authorized under section 411 of the Older 
Americans Act of 1965 (42 U.S.C. 3032) to conduct a public awareness 
and education campaign to encourage participation in the revised 
incentive program under subsection (a).
    (c) Submission of Plan.--Not later than 180 days after the date of 
enactment of this Act, the Secretary shall submit to Congress the plan 
developed under subsection (a).
    SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PROVIDER IDENTIFIERS 
      ON PHARMACY CLAIMS.
    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
        ``(4) Requiring valid prescriber national provider identifiers 
    on pharmacy claims.--
            ``(A) In general.--For plan year 2016 and subsequent plan 
        years, the Secretary shall require a claim for a covered part D 
        drug for a part D eligible individual enrolled in a 
        prescription drug plan under this part or an MA-PD plan under 
        part C to include a prescriber National Provider Identifier 
        that is determined to be valid under the procedures established 
        under subparagraph (B)(i).
            ``(B) Procedures.--
                ``(i) Validity of prescriber national provider 
            identifiers.--The Secretary, in consultation with 
            appropriate stakeholders, shall establish procedures for 
            determining the validity of prescriber National Provider 
            Identifiers under subparagraph (A).
                ``(ii) Informing beneficiaries of reason for denial.--
            The Secretary shall establish procedures to ensure that, in 
            the case that a claim for a covered part D drug of an 
            individual described in subparagraph (A) is denied because 
            the claim does not meet the requirements of this paragraph, 
            the individual is properly informed at the point of service 
            of the reason for the denial.
            ``(C) Report.--Not later than January 1, 2018, the 
        Inspector General of the Department of Health and Human 
        Services shall submit to Congress a report on the effectiveness 
        of the procedures established under subparagraph (B)(i).''.
    SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NOTICE ELECTRONICALLY.
    (a) In General.--Section 1806 of the Social Security Act (42 U.S.C. 
1395b-7) is amended by adding at the end the following new subsection:
    ``(c) Format of Statements From Secretary.--
        ``(1) Electronic option beginning in 2016.--Subject to 
    paragraph (2), for statements described in subsection (a) that are 
    furnished for a period in 2016 or a subsequent year, in the case 
    that an individual described in subsection (a) elects, in 
    accordance with such form, manner, and time specified by the 
    Secretary, to receive such statement in an electronic format, such 
    statement shall be furnished to such individual for each period 
    subsequent to such election in such a format and shall not be 
    mailed to the individual.
        ``(2) Limitation on revocation option.--
            ``(A) In general.--Subject to subparagraph (B), the 
        Secretary may determine a maximum number of elections described 
        in paragraph (1) by an individual that may be revoked by the 
        individual.
            ``(B) Minimum of one revocation option.--In no case may the 
        Secretary determine a maximum number under subparagraph (A) 
        that is less than one.
        ``(3) Notification.--The Secretary shall ensure that, in the 
    most cost effective manner and beginning January 1, 2017, a clear 
    notification of the option to elect to receive statements described 
    in subsection (a) in an electronic format is made available, such 
    as through the notices distributed under section 1804, to 
    individuals described in subsection (a).''.
    (b) Encouraged Expansion of Electronic Statements.--To the extent 
to which the Secretary of Health and Human Services determines 
appropriate, the Secretary shall--
        (1) apply an option similar to the option described in 
    subsection (c)(1) of section 1806 of the Social Security Act (42 
    U.S.C. 1395b-7) (relating to the provision of the Medicare Summary 
    Notice in an electronic format), as added by subsection (a), to 
    other statements and notifications under title XVIII of such Act 
    (42 U.S.C. 1395 et seq.); and
        (2) provide such Medicare Summary Notice and any such other 
    statements and notifications on a more frequent basis than is 
    otherwise required under such title.
    SEC. 509. RENEWAL OF MAC CONTRACTS.
    (a) In General.--Section 1874A(b)(1)(B) of the Social Security Act 
(42 U.S.C. 1395kk-1(b)(1)(B)) is amended by striking ``5 years'' and 
inserting ``10 years''.
    (b) Application.--The amendments made by subsection (a) shall apply 
to contracts entered into on or after, and to contracts in effect as 
of, the date of the enactment of this Act.
    (c) Contractor Performance Transparency.--Section 1874A(b)(3)(A) of 
the Social Security Act (42 U.S.C. 1395kk-1(b)(3)(A)) is amended by 
adding at the end the following new clause:
                ``(iv) Contractor performance transparency.--To the 
            extent possible without compromising the process for 
            entering into and renewing contracts with medicare 
            administrative contractors under this section, the 
            Secretary shall make available to the public the 
            performance of each medicare administrative contractor with 
            respect to such performance requirements and measurement 
            standards.''.
    SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES FOR STATE 
      PARTICIPATION IN MEDICAID DATA MATCH PROGRAM.
    Section 1893(g) of the Social Security Act (42 U.S.C. 1395ddd(g)) 
is amended by adding at the end the following new paragraph:
        ``(3) Incentives for states.--The Secretary shall study and, as 
    appropriate, may specify incentives for States to work with the 
    Secretary for the purposes described in paragraph (1)(A)(ii). The 
    application of the previous sentence may include use of the waiver 
    authority described in paragraph (2).''.
    SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE TO CLINICAL DATA 
      REGISTRIES.
    Not later than one year after the date of the enactment of this 
section, the Secretary of Health and Human Services shall issue a 
clarification or modification with respect to the application of 
subpart A of part 46 of title 45, Code of Federal Regulations, 
governing the protection of human subjects in research (and commonly 
known as the ``Common Rule''), to activities, including quality 
improvement activities, involving clinical data registries, including 
entities that are qualified clinical data registries pursuant to 
section 1848(m)(3)(E) of the Social Security Act (42 U.S.C. 1395w-
4(m)(3)(E)).
    SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES; GAINSHARING 
      STUDY AND REPORT.
    (a) Eliminating Civil Money Penalties for Inducements to Physicians 
To Limit Services That Are Not Medically Necessary.--
        (1) In general.--Section 1128A(b)(1) of the Social Security Act 
    (42 U.S.C. 1320a-7a(b)(1)) is amended by inserting ``medically 
    necessary'' after ``reduce or limit''.
        (2) Effective date.--The amendment made by paragraph (1) shall 
    apply to payments made on or after the date of the enactment of 
    this Act.
    (b) Gainsharing Study and Report.--Not later than 12 months after 
the date of the enactment of this Act, the Secretary of Health and 
Human Services, in consultation with the Inspector General of the 
Department of Health and Human Services, shall submit to Congress a 
report with options for amending existing fraud and abuse laws in, and 
regulations related to, titles XI and XVIII of the Social Security Act 
(42 U.S.C. 301 et seq.), through exceptions, safe harbors, or other 
narrowly targeted provisions, to permit gainsharing arrangements that 
otherwise would be subject to the civil money penalties described in 
paragraphs (1) and (2) of section 1128A(b) of such Act (42 U.S.C. 
1320a-7a(b)), or similar arrangements between physicians and hospitals, 
and that improve care while reducing waste and increasing efficiency. 
The report shall--
        (1) consider whether such provisions should apply to ownership 
    interests, compensation arrangements, or other relationships;
        (2) describe how the recommendations address accountability, 
    transparency, and quality, including how best to limit inducements 
    to stint on care, discharge patients prematurely, or otherwise 
    reduce or limit medically necessary care; and
        (3) consider whether a portion of any savings generated by such 
    arrangements (as compared to an historical benchmark or other 
    metric specified by the Secretary to determine the impact of 
    delivery and payment system changes under such title XVIII on 
    expenditures made under such title) should accrue to the Medicare 
    program under title XVIII of the Social Security Act.
    SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH SURETY BOND 
      CONDITION OF PARTICIPATION REQUIREMENT.
    Section 1861(o)(7) of the Social Security Act (42 U.S.C. 
1395x(o)(7)) is amended to read as follows:
        ``(7) provides the Secretary with a surety bond--
            ``(A) in a form specified by the Secretary and in an amount 
        that is not less than the minimum of $50,000; and
            ``(B) that the Secretary determines is commensurate with 
        the volume of payments to the home health agency; and''.
    SEC. 514. OVERSIGHT OF MEDICARE COVERAGE OF MANUAL MANIPULATION OF 
      THE SPINE TO CORRECT SUBLUXATION.
    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the following new subsection:
    ``(z) Medical Review of Spinal Subluxation Services.--
        ``(1) In general.--The Secretary shall implement a process for 
    the medical review (as described in paragraph (2)) of treatment by 
    a chiropractor described in section 1861(r)(5) by means of manual 
    manipulation of the spine to correct a subluxation (as described in 
    such section) of an individual who is enrolled under this part and 
    apply such process to such services furnished on or after January 
    1, 2017, focusing on services such as--
            ``(A) services furnished by a such a chiropractor whose 
        pattern of billing is aberrant compared to peers; and
            ``(B) services furnished by such a chiropractor who, in a 
        prior period, has a services denial percentage in the 85th 
        percentile or greater, taking into consideration the extent 
        that service denials are overturned on appeal.
        ``(2) Medical review.--
            ``(A) Prior authorization medical review.--
                ``(i) In general.--Subject to clause (ii), the 
            Secretary shall use prior authorization medical review for 
            services described in paragraph (1) that are furnished to 
            an individual by a chiropractor described in section 
            1861(r)(5) that are part of an episode of treatment that 
            includes more than 12 services. For purposes of the 
            preceding sentence, an episode of treatment shall be 
            determined by the underlying cause that justifies the need 
            for services, such as a diagnosis code.
                ``(ii) Ending application of prior authorization 
            medical review.--The Secretary shall end the application of 
            prior authorization medical review under clause (i) to 
            services described in paragraph (1) by such a chiropractor 
            if the Secretary determines that the chiropractor has a low 
            denial rate under such prior authorization medical review. 
            The Secretary may subsequently reapply prior authorization 
            medical review to such chiropractor if the Secretary 
            determines it to be appropriate and the chiropractor has, 
            in the time period subsequent to the determination by the 
            Secretary of a low denial rate with respect to the 
            chiropractor, furnished such services described in 
            paragraph (1).
                ``(iii) Early request for prior authorization review 
            permitted.--Nothing in this subsection shall be construed 
            to prevent such a chiropractor from requesting prior 
            authorization for services described in paragraph (1) that 
            are to be furnished to an individual before the 
            chiropractor furnishes the twelfth such service to such 
            individual for an episode of treatment.
            ``(B) Type of review.--The Secretary may use pre-payment 
        review or post-payment review of services described in section 
        1861(r)(5) that are not subject to prior authorization medical 
        review under subparagraph (A).
            ``(C) Relationship to law enforcement activities.--The 
        Secretary may determine that medical review under this 
        subsection does not apply in the case where potential fraud may 
        be involved.
        ``(3) No payment without prior authorization.--With respect to 
    a service described in paragraph (1) for which prior authorization 
    medical review under this subsection applies, the following shall 
    apply:
            ``(A) Prior authorization determination.--The Secretary 
        shall make a determination, prior to the service being 
        furnished, of whether the service would or would not meet the 
        applicable requirements of section 1862(a)(1)(A).
            ``(B) Denial of payment.--Subject to paragraph (5), no 
        payment may be made under this part for the service unless the 
        Secretary determines pursuant to subparagraph (A) that the 
        service would meet the applicable requirements of such section 
        1862(a)(1)(A).
        ``(4) Submission of information.--A chiropractor described in 
    section 1861(r)(5) may submit the information necessary for medical 
    review by fax, by mail, or by electronic means. The Secretary shall 
    make available the electronic means described in the preceding 
    sentence as soon as practicable.
        ``(5) Timeliness.--If the Secretary does not make a prior 
    authorization determination under paragraph (3)(A) within 14 
    business days of the date of the receipt of medical documentation 
    needed to make such determination, paragraph (3)(B) shall not 
    apply.
        ``(6) Application of limitation on beneficiary liability.--
    Where payment may not be made as a result of the application of 
    paragraph (2)(B), section 1879 shall apply in the same manner as 
    such section applies to a denial that is made by reason of section 
    1862(a)(1).
        ``(7) Review by contractors.--The medical review described in 
    paragraph (2) may be conducted by medicare administrative 
    contractors pursuant to section 1874A(a)(4)(G) or by any other 
    contractor determined appropriate by the Secretary that is not a 
    recovery audit contractor.
        ``(8) Multiple services.--The Secretary shall, where 
    practicable, apply the medical review under this subsection in a 
    manner so as to allow an individual described in paragraph (1) to 
    obtain, at a single time rather than on a service-by-service basis, 
    an authorization in accordance with paragraph (3)(A) for multiple 
    services.
        ``(9) Construction.--With respect to a service described in 
    paragraph (1) that has been affirmed by medical review under this 
    subsection, nothing in this subsection shall be construed to 
    preclude the subsequent denial of a claim for such service that 
    does not meet other applicable requirements under this Act.
        ``(10) Implementation.--
            ``(A) Authority.--The Secretary may implement the 
        provisions of this subsection by interim final rule with 
        comment period.
            ``(B) Administration.--Chapter 35 of title 44, United 
        States Code, shall not apply to medical review under this 
        subsection.''.
    (b) Improving Documentation of Services.--
        (1) In general.--The Secretary of Health and Human Services 
    shall, in consultation with stakeholders (including the American 
    Chiropractic Association) and representatives of medicare 
    administrative contractors (as defined in section 1874A(a)(3)(A) of 
    the Social Security Act (42 U.S.C. 1395kk-1(a)(3)(A))), develop 
    educational and training programs to improve the ability of 
    chiropractors to provide documentation to the Secretary of services 
    described in section 1861(r)(5) in a manner that demonstrates that 
    such services are, in accordance with section 1862(a)(1) of such 
    Act (42 U.S.C. 1395y(a)(1)), reasonable and necessary for the 
    diagnosis or treatment of illness or injury or to improve the 
    functioning of a malformed body member.
        (2) Timing.--The Secretary shall make the educational and 
    training programs described in paragraph (1) publicly available not 
    later than January 1, 2016.
        (3) Funding.--The Secretary shall use funds made available 
    under paragraph (10) of section 1893(h) of the Social Security Act 
    (42 U.S.C. 1395ddd(h)), as added by section 505, to carry out this 
    subsection.
    (c) GAO Study and Report.--
        (1) Study.--The Comptroller General of the United States shall 
    conduct a study on the effectiveness of the process for medical 
    review of services furnished as part of a treatment by means of 
    manual manipulation of the spine to correct a subluxation 
    implemented under subsection (z) of section 1833 of the Social 
    Security Act (42 U.S.C. 1395l), as added by subsection (a). Such 
    study shall include an analysis of--
            (A) aggregate data on--
                (i) the number of individuals, chiropractors, and 
            claims for services subject to such review; and
                (ii) the number of reviews conducted under such 
            section; and
            (B) the outcomes of such reviews.
        (2) Report.--Not later than four years after the date of 
    enactment of this Act, the Comptroller General shall submit to 
    Congress a report containing the results of the study conducted 
    under paragraph (1), including recommendations for such legislation 
    and administrative action with respect to the process for medical 
    review implemented under subsection (z) of section 1833 of the 
    Social Security Act (42 U.S.C. 1395l) as the Comptroller General 
    determines appropriate.
    SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZATION MODEL FOR 
      REPETITIVE SCHEDULED NON-EMERGENT AMBULANCE TRANSPORT.
    (a) Initial Expansion.--
        (1) In general.--In implementing the model described in 
    paragraph (2) proposed to be tested under subsection (b) of section 
    1115A of the Social Security Act (42 U.S.C. 1315a), the Secretary 
    of Health and Human Services shall revise the testing under 
    subsection (b) of such section to cover, effective not later than 
    January 1, 2016, States located in medicare administrative 
    contractor (MAC) regions L and 11 (consisting of Delaware, the 
    District of Columbia, Maryland, New Jersey, Pennsylvania, North 
    Carolina, South Carolina, West Virginia, and Virginia).
        (2) Model described.--The model described in this paragraph is 
    the testing of a model of prior authorization for repetitive 
    scheduled non-emergent ambulance transport proposed to be carried 
    out in New Jersey, Pennsylvania, and South Carolina.
        (3) Funding.--The Secretary shall allocate funds made available 
    under section 1115A(f)(1)(B) of the Social Security Act (42 U.S.C. 
    1315a(f)(1)(B)) to carry out this subsection.
    (b) National Expansion.--Section 1834(l) of the Social Security Act 
(42 U.S.C. 1395m(l)) is amended by adding at the end the following new 
paragraph:
        ``(16) Prior authorization for repetitive scheduled non-
    emergent ambulance transports.--
            ``(A) In general.--Beginning January 1, 2017, if the 
        expansion to all States of the model of prior authorization 
        described in paragraph (2) of section 515(a) of the Medicare 
        Access and CHIP Reauthorization Act of 2015 meets the 
        requirements described in paragraphs (1) through (3) of section 
        1115A(c), then the Secretary shall expand such model to all 
        States.
            ``(B) Funding.--The Secretary shall use funds made 
        available under section 1893(h)(10) to carry out this 
        paragraph.
            ``(C) Clarification regarding budget neutrality.--Nothing 
        in this paragraph may be construed to limit or modify the 
        application of section 1115A(b)(3)(B) to models described in 
        such section, including with respect to the model described in 
        subparagraph (A) and expanded beginning on January 1, 2017, 
        under such subparagraph.''.
    SEC. 516. REPEALING DUPLICATIVE MEDICARE SECONDARY PAYOR PROVISION.
    (a) In General.--Section 1862(b)(5) of the Social Security Act (42 
U.S.C. 1395y(b)(5)) is amended by inserting at the end the following 
new subparagraph:
            ``(E) End date.--The provisions of this paragraph shall not 
        apply to information required to be provided on or after July 
        1, 2016.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act and shall apply to 
information required to be provided on or after January 1, 2016.
    SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT REPORT.
    Not later than June 30, 2015, the Secretary of Health and Human 
Services shall submit to the Committee on Finance of the Senate, and to 
the Committees on Energy and Commerce and Ways and Means of the House 
of Representatives--
        (1) a plan for including, in the annual report of the 
    Comprehensive Error Rate Testing (CERT) program, data on services 
    (or groupings of services) (other than medical visits) paid under 
    the physician fee schedule under section 1848 of the Social 
    Security Act (42 U.S.C. 1395w-4) where the fee schedule amount is 
    in excess of $250 and where the error rate is in excess of 20 
    percent; and
        (2) to the extent practicable by such date, specific examples 
    of services described in paragraph (1).
    SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVEMENT FUND ADDED BY 
      IMPACT ACT OF 2014.
    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)), as amended by section 3(e)(3) of the IMPACT Act of 2014 
(Public Law 113-185), is amended by striking ``$195,000,000'' and 
inserting ``$0''.
    SEC. 519. RULE OF CONSTRUCTION.
    Except as explicitly provided in this subtitle, nothing in this 
subtitle, including the amendments made by this subtitle, shall be 
construed as preventing the use of notice and comment rulemaking in the 
implementation of the provisions of, and the amendments made by, this 
subtitle.

                      Subtitle B--Other Provisions

    SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON CERTAIN MEDICAL 
      REVIEW ACTIVITIES.
    Section 111 of the Protecting Access to Medicare Act of 2014 
(Public Law 113-93; 42 U.S.C. 1395ddd note) is amended--
        (1) in subsection (a), by striking ``the first 6 months of 
    fiscal year 2015'' and inserting ``through the end of fiscal year 
    2015'';
        (2) in subsection (b), by striking ``March 31, 2015'' and 
    inserting ``September 30, 2015''; and
        (3) by adding at the end the following new subsection:
    ``(c) Construction.--Except as provided in subsections (a) and (b), 
nothing in this section shall be construed as limiting the Secretary's 
authority to pursue fraud and abuse activities under such section 
1893(h) or otherwise.''.
    SEC. 522. REQUIRING BID SURETY BONDS AND STATE LICENSURE FOR 
      ENTITIES SUBMITTING BIDS UNDER THE MEDICARE DMEPOS COMPETITIVE 
      ACQUISITION PROGRAM.
    (a) Bid Surety Bonds.--Section 1847(a)(1) of the Social Security 
Act (42 U.S.C. 1395w-3(a)(1)) is amended by adding at the end the 
following new subparagraphs:
            ``(G) Requiring bid bonds for bidding entities.--With 
        respect to rounds of competitions beginning under this 
        subsection for contracts beginning not earlier than January 1, 
        2017, and not later than January 1, 2019, an entity may not 
        submit a bid for a competitive acquisition area unless, as of 
        the deadline for bid submission, the entity has obtained (and 
        provided the Secretary with proof of having obtained) a bid 
        surety bond (in this paragraph referred to as a `bid bond') in 
        a form specified by the Secretary consistent with subparagraph 
        (H) and in an amount that is not less than $50,000 and not more 
        than $100,000 for each competitive acquisition area in which 
        the entity submits the bid.
            ``(H) Treatment of bid bonds submitted.--
                ``(i) For bidders that submit bids at or below the 
            median and are offered but do not accept the contract.--In 
            the case of a bidding entity that is offered a contract for 
            any product category for a competitive acquisition area, 
            if--

                    ``(I) the entity's composite bid for such product 
                category and area was at or below the median composite 
                bid rate for all bidding entities included in the 
                calculation of the single payment amounts for such 
                product category and area; and
                    ``(II) the entity does not accept the contract 
                offered for such product category and area,

            the bid bond submitted by such entity for such area shall 
            be forfeited by the entity and the Secretary shall collect 
            on it.
                ``(ii) Treatment of other bidders.--In the case of a 
            bidding entity for any product category for a competitive 
            acquisition area, if the entity does not meet the bid 
            forfeiture conditions in subclauses (I) and (II) of clause 
            (i) for any product category for such area, the bid bond 
            submitted by such entity for such area shall be returned 
            within 90 days of the public announcement of the contract 
            suppliers for such area.''.
    (b) State Licensure.--
        (1) In general.--Section 1847(b)(2)(A) of the Social Security 
    Act (42 U.S.C. 1395w-3(b)(2)(A)) is amended by adding at the end 
    the following new clause:
                ``(v) The entity meets applicable State licensure 
            requirements.''.
        (2) Construction.--Nothing in the amendment made by paragraph 
    (1) shall be construed as affecting the authority of the Secretary 
    of Health and Human Services to require State licensure of an 
    entity under the Medicare competitive acquisition program under 
    section 1847 of the Social Security Act (42 U.S.C. 1395w-3) before 
    the date of the enactment of this Act.
    (c) GAO Report on Bid Bond Impact on Small Suppliers.--
        (1) Study.--The Comptroller General of the United States shall 
    conduct a study that evaluates the effect of the bid surety bond 
    requirement under the amendment made by subsection (a) on the 
    participation of small suppliers in the Medicare DMEPOS competitive 
    acquisition program under section 1847 of the Social Security Act 
    (42 U.S.C. 1395w-3).
        (2) Report.--Not later than 6 months after the date contracts 
    are first awarded subject to such bid surety bond requirement, the 
    Comptroller General shall submit to Congress a report on the study 
    conducted under paragraph (1). Such report shall include 
    recommendations for changes in such requirement in order to ensure 
    robust participation by legitimate small suppliers in the Medicare 
    DMEPOS competition acquisition program.
    SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES.
    (a) In General.--Section 1848(c) of the Social Security Act (42 
U.S.C. 1395w-4(c)) is amended by adding at the end the following new 
paragraph:
        ``(8) Global surgical packages.--
            ``(A) Prohibition of implementation of rule regarding 
        global surgical packages.--
                ``(i) In general.--The Secretary shall not implement 
            the policy established in the final rule published on 
            November 13, 2014 (79 Fed. Reg. 67548 et seq.), that 
            requires the transition of all 10-day and 90-day global 
            surgery packages to 0-day global periods.
                ``(ii) Construction.--Nothing in clause (i) shall be 
            construed to prevent the Secretary from revaluing misvalued 
            codes for specific surgical services or assigning values to 
            new or revised codes for surgical services.
            ``(B) Collection of data on services included in global 
        surgical packages.--
                ``(i) In general.--Subject to clause (ii), the 
            Secretary shall through rulemaking develop and implement a 
            process to gather, from a representative sample of 
            physicians, beginning not later than January 1, 2017, 
            information needed to value surgical services. Such 
            information shall include the number and level of medical 
            visits furnished during the global period and other items 
            and services related to the surgery and furnished during 
            the global period, as appropriate. Such information shall 
            be reported on claims at the end of the global period or in 
            another manner specified by the Secretary. For purposes of 
            carrying out this paragraph (other than clause (iii)), the 
            Secretary shall transfer from the Federal Supplemental 
            Medical Insurance Trust Fund under section 1841 $2,000,000 
            to the Center for Medicare & Medicaid Services Program 
            Management Account for fiscal year 2015. Amounts 
            transferred under the previous sentence shall remain 
            available until expended.
                ``(ii) Reassessment and potential sunset.--Every 4 
            years, the Secretary shall reassess the value of the 
            information collected pursuant to clause (i). Based on such 
            a reassessment and by regulation, the Secretary may 
            discontinue the requirement for collection of information 
            under such clause if the Secretary determines that the 
            Secretary has adequate information from other sources, such 
            as qualified clinical data registries, surgical logs, 
            billing systems or other practice or facility records, and 
            electronic health records, in order to accurately value 
            global surgical services under this section.
                ``(iii) Inspector general audit.--The Inspector General 
            of the Department of Health and Human Services shall audit 
            a sample of the information reported under clause (i) to 
            verify the accuracy of the information so reported.
            ``(C) Improving accuracy of pricing for surgical 
        services.--For years beginning with 2019, the Secretary shall 
        use the information reported under subparagraph (B)(i) as 
        appropriate and other available data for the purpose of 
        improving the accuracy of valuation of surgical services under 
        the physician fee schedule under this section.''.
    (b) Incentive for Reporting Information on Global Surgical 
Services.--Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-
4(a)) is amended by adding at the end the following new paragraph:
        ``(9) Information reporting on services included in global 
    surgical packages.--With respect to services for which a physician 
    is required to report information in accordance with subsection 
    (c)(8)(B)(i), the Secretary may through rulemaking delay payment of 
    5 percent of the amount that would otherwise be payable under the 
    physician fee schedule under this section for such services until 
    the information so required is reported.''.
    SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND COMMUNITY SELF-
      DETERMINATION ACT OF 2000.
    (a) Payments for Fiscal Years 2014 and 2015.--
        (1) Payments required.--Section 101 of the Secure Rural Schools 
    and Community Self-Determination Act of 2000 (16 U.S.C. 7111) is 
    amended by striking ``2013'' both places it appears and inserting 
    ``2015''.
        (2) Prompt payment.--Payments for fiscal year 2014 under title 
    I of the Secure Rural Schools and Community Self-Determination Act 
    of 2000 (16 U.S.C. 7111 et seq.), as amended by this section, shall 
    be made not later than 45 days after the date of the enactment of 
    this Act.
        (3) Reduction in fiscal year 2014 payments on account of 
    previous 25- and 50-percent payments.--Section 101 of the Secure 
    Rural Schools and Community Self-Determination Act of 2000 (16 
    U.S.C. 7111) is amended by adding at the end the following new 
    subsection:
    ``(c) Special Rule for Fiscal Year 2014 Payments.--
        ``(1) State payment.--If an eligible county in a State that 
    will receive a share of the State payment for fiscal year 2014 has 
    already received, or will receive, a share of the 25-percent 
    payment for fiscal year 2014 distributed to the State before the 
    date of the enactment of this subsection, the amount of the State 
    payment shall be reduced by the amount of that eligible county's 
    share of the 25-percent payment.
        ``(2) County payment.--If an eligible county that will receive 
    a county payment for fiscal year 2014 has already received a 50-
    percent payment for that fiscal year, the amount of the county 
    payment shall be reduced by the amount of the 50-percent 
    payment.''.
        (4) Shares of california state payment.--Section 103(d)(2) of 
    the Secure Rural Schools and Community Self-Determination Act of 
    2000 (16 U.S.C. 7113(d)(2)) is amended by striking ``2013'' and 
    inserting ``2015''.
    (b) Use of Fiscal Year 2013 Elections and Reservations for Fiscal 
Years 2014 and 2015.--Section 102 of the Secure Rural Schools and 
Community Self-Determination Act of 2000 (16 U.S.C. 7112) is amended--
        (1) in subsection (b)(1), by adding at the end the following 
    new subparagraph:
            ``(C) Effect of late payment for fiscal years 2014 and 
        2015.--The election otherwise required by subparagraph (A) 
        shall not apply for fiscal year 2014 or 2015.'';
        (2) in subsection (b)(2)--
            (A) in subparagraph (A), by adding at the end the following 
        new sentence: ``If such two-fiscal year period included fiscal 
        year 2013, the county election to receive a share of the 25-
        percent payment or 50-percent payment, as applicable, also 
        shall be effective for fiscal years 2014 and 2015.''; and
            (B) in subparagraph (B), by striking ``2013'' the second 
        place it appears and inserting ``2015''; and
        (3) in subsection (d)--
            (A) by adding at the end of paragraph (1) the following new 
        subparagraph:
            ``(E) Effect of late payment for fiscal year 2014.--The 
        election made by an eligible county under subparagraph (B), 
        (C), or (D) for fiscal year 2013, or deemed to be made by the 
        county under paragraph (3)(B) for that fiscal year, shall be 
        effective for fiscal years 2014 and 2015.''; and
            (B) by adding at the end of paragraph (3) the following new 
        subparagraph:
            ``(C) Effect of late payment for fiscal year 2014.--This 
        paragraph does not apply for fiscal years 2014 and 2015.''.
    (c) Special Projects on Federal Land.--Title II of the Secure Rural 
Schools and Community Self-Determination Act of 2000 (16 U.S.C. 7121 et 
seq.) is amended--
        (1) in section 203(a)(1) (16 U.S.C. 7123(a)(1)), by striking 
    ``September 30 for fiscal year 2008 (or as soon thereafter as the 
    Secretary concerned determines is practicable), and each September 
    30 thereafter for each succeeding fiscal year through fiscal year 
    2013'' and inserting ``September 30 of each fiscal year (or a later 
    date specified by the Secretary concerned for the fiscal year)'';
        (2) in section 204(e)(3)(B)(iii) (16 U.S.C. 
    7124(e)(3)(B)(iii)), by striking ``each of fiscal years 2010 
    through 2013'' and inserting ``fiscal year 2010 and fiscal years 
    thereafter'';
        (3) in section 207(a) (16 U.S.C. 7127(a)), by striking 
    ``September 30, 2008 (or as soon thereafter as the Secretary 
    concerned determines is practicable), and each September 30 
    thereafter for each succeeding fiscal year through fiscal year 
    2013'' and inserting ``September 30 of each fiscal year (or a later 
    date specified by the Secretary concerned for the fiscal year)''; 
    and
        (4) in section 208 (16 U.S.C. 7128)--
            (A) in subsection (a), by striking ``2013'' and inserting 
        ``2017''; and
            (B) in subsection (b), by striking ``2014'' and inserting 
        ``2018''.
    (d) County Funds.--Section 304 of the Secure Rural Schools and 
Community Self-Determination Act of 2000 (16 U.S.C. 7144) is amended--
        (1) in subsection (a), by striking ``2013'' and inserting 
    ``2017''; and
        (2) in subsection (b), by striking ``2014'' and inserting 
    ``2018''.
    (e) Authorization of Appropriations.--Section 402 of the Secure 
Rural Schools and Community Self-Determination Act of 2000 (16 U.S.C. 
7152) is amended by striking ``for each of fiscal years 2008 through 
2013''.
    SEC. 525. EXCLUSION FROM PAYGO SCORECARDS.
    (a) Statutory Pay-As-You-Go Scorecards.--The budgetary effects of 
this Act shall not be entered on either PAYGO scorecard maintained 
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of this Act 
shall not be entered on any PAYGO scorecard maintained for purposes of 
section 201 of S. Con. Res. 21 (110th Congress).

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```