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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3298 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 3298

 To amend title XVIII of the Social Security Act to provide for value-
    based purchasing of post-acute care services under the Medicare 
                    program, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 29, 2015

Mr. Brady of Texas (for himself and Mr. Kind) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL

 
 To amend title XVIII of the Social Security Act to provide for value-
    based purchasing of post-acute care services under the Medicare 
                    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.

    This Act may be cited as the ``Medicare Post-Acute Care Value-Based 
Purchasing Act of 2015''.

SEC. 2. REPEAL OF MARKET BASKET CUTS FOR POST-ACUTE PROVIDERS.

    (a) SNFs.--Section 1888(e) of the Social Security Act (42 U.S.C. 
1395yy(e)), as amended by section 411(a) of the Medicare Access and 
CHIP Reauthorization Act of 2015, is amended--
            (1) in paragraph (5)(B)--
                    (A) in clause (i), by striking ``clauses (ii) and 
                (iii)'' and inserting ``clause (ii)'';
                    (B) in clause (ii), by striking ``subject to clause 
                (iii),''; and
                    (C) by striking clause (iii); and
            (2) in paragraph (6)(A)(i), by striking ``clauses (ii) and 
        (iii) of paragraph (5)(B)'' and inserting ``paragraph 
        (5)(B)(ii)''.
    (b) IRFs.--Section 1886(j) of the Social Security Act (42 U.S.C. 
1395ww(j)), as amended by section 411(b) of the Medicare Access and 
CHIP Reauthorization Act of 2015, is amended--
            (1) in paragraph (3)(C)--
                    (A) in clause (i), by striking ``clauses (ii) and 
                (iii)'' and inserting ``clause (ii)'';
                    (B) in clause (ii), by striking ``Subject to clause 
                (iii), after'' and inserting ``After'' ; and
                    (C) by striking clause (iii); and
            (2) in paragraph (7)(A)(i), by striking ``subparagraphs 
        (C)(iii) and (D) of paragraph (3)'' and inserting ``paragraph 
        (3)(D)''.
    (c) HHAs.--Section 1895(b)(3)(B) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)), as amended by section 411(c) of the Medicare 
Access and CHIP Reauthorization Act of 2015, is amended--
            (1) in clause (iii), by striking the last sentence; and
            (2) in clause (vi)(I), by striking ``(except 2018)''.
    (d) LTCHs.--Section 1886(m)(3) of the Social Security Act (42 
U.S.C. 1395ww(m)(3)), as amended by section 411(e) of the Medicare 
Access and CHIP Reauthorization Act of 2015, is amended--
            (1) in subparagraph (A), by striking ``Subject to 
        subparagraph (C), in implementing'' and inserting ``In 
        implementing''; and
            (2) by striking subparagraph (C).
    (e) Effective Date.--The amendments made by this section shall be 
effective as if included in the enactment of the Medicare Access and 
CHIP Reauthorization Act of 2015.

SEC. 3. POST-ACUTE CARE VALUE-BASED PURCHASING PROGRAM.

    (a) In General.--Section 1899B of the Social Security Act (42 
U.S.C. 1395lll) is amended--
            (1) in the heading, by inserting ``; post-acute care value-
        based purchasing program'' before the period at the end; and
            (2) by adding at the end the following new subsection:
    ``(n) Post-Acute Care Value-Based Purchasing Program (PAC VBP 
Program).--
            ``(1) Establishment.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, the Secretary shall 
                establish a post-acute care value-based purchasing 
                program (in this subsection referred to as the `PAC VBP 
                Program') under which value-based incentive payments 
                are made in a payment year to PAC providers.
                    ``(B) Program implementation.--The PAC VBP Program 
                shall apply to payments for services furnished in 
                payment years beginning on or after October 1, 2019.
                    ``(C) Treatment of new pac providers.--In the case 
                of a PAC provider that first begins participation in 
                the program under this title during the performance 
                period for a payment year (and had not previously 
                submitted claims under this title as such a provider 
                under a different billing number or tax identifier), 
                such provider shall not be treated under this 
                subsection as a PAC provider until the subsequent 
                payment year and performance period for such subsequent 
                payment year.
                    ``(D) Payment year defined.--In this subsection, 
                the term `payment year' means--
                            ``(i) for PAC providers described in clause 
                        (i) of subsection (a)(2)(A) (relating to home 
                        health agencies), a calendar year; and
                            ``(ii) for all other PAC providers, a 
                        fiscal year.
                    ``(E) Type of provider defined.--In this 
                subsection, the term `provider type' means, with 
                respect to PAC providers, each of the types of PAC 
                providers described in a clause in subsection 
                (a)(2)(A).
            ``(2) Application of measure.--
                    ``(A) In general.--Under the PAC VBP Program, the 
                Secretary shall apply the resource use measure 
                specified under subsection (d)(1)(A) for purposes of 
                the PAC VBP Program.
                    ``(B) Application on provider and area basis.--Such 
                measure shall be applied separately--
                            ``(i) for each PAC provider; and
                            ``(ii) for all PAC providers, regardless of 
                        type, in each hospital service area or 
                        comparable area (as determined by the 
                        Secretary) in which an individual receives a 
                        service from any PAC provider involved under 
                        this title in such area.
            ``(3) Performance standards.--
                    ``(A) Establishment.--The Secretary shall establish 
                performance standards consistent with this paragraph 
                with respect to the measure applied under paragraph (2) 
                for a performance period for a payment year.
                    ``(B) Higher of achievement and improvement.--The 
                performance standards established under subparagraph 
                (A) shall include levels of achievement and 
                improvement. In calculating the performance score of a 
                PAC provider (including an area) under paragraph (4), 
                the Secretary shall use the higher of either 
                improvement or achievement.
                    ``(C) Timing.--The Secretary shall establish and 
                announce the performance standards established under 
                subparagraph (A) not later than 90 days before the 
                beginning of the performance period for the payment 
                year involved.
            ``(4) PAC performance scores.--
                    ``(A) In general.--The Secretary shall develop a 
                methodology for assessing the total performance of each 
                PAC provider, and of each hospital service area or 
                comparable area (as determined by the Secretary, based 
                on performance standards established under paragraph 
                (3) with respect to the measure applied under paragraph 
                (2) for a performance period for a payment year.
                    ``(B) Computation of individual, area, and 
                composite performance scores.--Using such methodology, 
                the Secretary shall provide for--
                            ``(i) an assessment, based on the measure 
                        applied under paragraph (2)(B)(i), for each 
                        individual PAC provider for each performance 
                        period;
                            ``(ii) an assessment, based on the measure 
                        applied under paragraph (2)(B)(ii), for all PAC 
                        providers in each area described in such 
                        paragraph for each performance period; and
                            ``(iii) a composite assessment (in this 
                        subsection referred to as the `PAC composite 
                        performance score') for each PAC provider for 
                        each performance period equal to the sum of--
                                    ``(I) 55 percent of the performance 
                                score under clause (i) for the period 
                                for that PAC provider; and
                                    ``(II) 45 percent of the 
                                performance score under clause (ii) for 
                                the period for all PAC providers 
                                located in the area in which the PAC 
                                provider is located.
                    ``(C) Ranking of pac performance scores.--The 
                Secretary shall, for the performance period for each 
                payment year for each type of PAC provider, rank the 
                PAC composite performance scores determined under 
                subparagraph (B)(iii) from low to high.
            ``(5) Calculation of value-based incentive payments.--
                    ``(A) In general.--With respect to a PAC provider, 
                based on the ranking under paragraph (4)(C) for a 
                performance period for a payment year, the Secretary 
                shall increase the payment basis specified in 
                subparagraph (B) otherwise applicable to such provider 
                for services furnished by such provider during such 
                payment year by the value-based incentive payment 
                percentage specified under subparagraph (C) for the 
                provider and payment year.
                    ``(B) Payment basis.--The payment basis specified 
                in this subparagraph for a type of provider is as 
                follows, as applied after the application of paragraph 
                (6):
                            ``(i) Skilled nursing facilities.--For 
                        skilled nursing facilities, the adjusted 
                        Federal per diem rate under section 
                        1888(e)(4)(B).
                            ``(ii) Inpatient rehabilitation 
                        facilities.--For inpatient rehabilitation 
                        facilities, the prospective per unit payment 
                        rate under section 1886(j)(3).
                            ``(iii) Long-term care hospitals.--For 
                        long-term care hospitals, the standard Federal 
                        rate under section 1886(m), or, if applicable, 
                        the applicable site neutral payment rate under 
                        paragraph (6) of such section.
                            ``(iv) Home health agencies.--For home 
                        health agencies, the standard prospective 
                        payment amount (or amounts) under section 
                        1895(b)(3).
                    ``(C) Value-based incentive payment percentage.--
                The Secretary shall specify a value-based incentive 
                payment percentage for each PAC provider for a payment 
                year, which may include a zero percentage but not a 
                percentage below zero. In specifying the value-based 
                incentive payment percentage for each PAC provider for 
                a payment year under this subparagraph, the Secretary 
                shall ensure that--
                            ``(i) such percentage is based on the 
                        ranking of PAC composite performance score of 
                        the provider under paragraph (4) for the 
                        performance period for the payment year;
                            ``(ii) the application of all such 
                        percentages for a type of PAC provider for a 
                        payment year results in an appropriate 
                        distribution of value-based incentive increases 
                        under subparagraph (A) such that--
                                    ``(I) PAC providers with the 
                                highest rankings under paragraph (4)(C) 
                                receive the highest value-based 
                                incentive payment percentages under 
                                this subparagraph; and
                                    ``(II) PAC providers with the 
                                lowest rankings under such paragraph 
                                receive the lowest value-based 
                                incentive payment percentages under 
                                this subparagraph; and
                            ``(iii) the total amount of value-based 
                        incentive increases under this paragraph for 
                        all PAC providers for each type of provider in 
                        such payment year shall be at least 50 percent, 
                        but not greater than 70 percent, of the total 
                        amount of the reductions to payments for PAC 
                        providers of such type for such payment year 
                        under paragraph (6), as estimated by the 
                        Secretary.
            ``(6) Funding for value-based incentive payments.--
                    ``(A) In general.--The Secretary shall reduce the 
                payment basis (as defined in paragraph (5)(B)), not 
                taking into account any increase under paragraph (5), 
                for each type of PAC provider for each payment year 
                beginning--
                            ``(i) during fiscal year 2020 by 3 percent;
                            ``(ii) during fiscal year 2021 by 4 
                        percent;
                            ``(iii) during fiscal year 2022 by 5 
                        percent;
                            ``(iv) during fiscal year 2023 by 6 
                        percent;
                            ``(v) during fiscal year 2024 by 7 percent; 
                        and
                            ``(vi) during or after fiscal year 2025 by 
                        8 percent.
                    ``(B) Implementation.--The Secretary shall make 
                such reductions for all PAC providers in the payment 
                year involved, regardless of whether or not the PAC 
                provider has been determined by the Secretary to have 
                earned a value-based incentive payment increase under 
                paragraph (5) for such payment year.
            ``(7) Announcement of net result of adjustments.--Under the 
        PAC VBP Program, the Secretary shall, not later than 90 days 
        prior to the payment year involved, inform each PAC provider of 
        the adjustments to payments to the PAC provider for services 
        furnished by such provider during the payment year under 
        paragraphs (5) and (6).
            ``(8) No effect in subsequent fiscal years.--The value-
        based incentive payment increase under paragraph (5) and the 
        payment reduction under paragraph (6) shall each apply only 
        with respect to the payment year involved, and the Secretary 
        shall not take into account such value-based incentive payment 
        increase or payment reduction in making payments to a PAC 
        provider under this title in a subsequent payment year.
            ``(9) Public reporting.--
                    ``(A) PAC specific information.--The Secretary 
                shall make available to the public, by posting on the 
                relevant Compare Medicare website (or a successor 
                website) in an easily understandable format, 
                information regarding the performance of individual PAC 
                providers under the PAC VBP Program, with respect to a 
                payment year, including--
                            ``(i) the PAC composite performance score 
                        of the PAC provider for such payment year; and
                            ``(ii) the ranking of the PAC provider 
                        under paragraph (4)(C) for the performance 
                        period for such payment year.
                    ``(B) Aggregate information.--The Secretary shall 
                periodically post on the relevant websites referred to 
                in subparagraph (A) aggregate information on the PAC 
                VBP Program for the types of providers, including--
                            ``(i) the range of PAC composite 
                        performance scores under paragraph (4)(B); and
                            ``(ii) the number of PAC providers of each 
                        type receiving value-based incentive payment 
                        increases under paragraph (5) and the range and 
                        total amount of such value-based incentive 
                        payment increases.
            ``(10) Limitation on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise of the following:
                    ``(A) The establishment of the performance 
                standards under paragraph (3) and the performance 
                period.
                    ``(B) The methodology developed under paragraph (4) 
                that is used to calculate PAC composite performance 
                scores and the calculation of such scores.
                    ``(C) The ranking determinations under paragraph 
                (4)(C).
                    ``(D) The methodology used to determine the value-
                based incentive payment percentages under paragraph 
                (5).
                    ``(E) The determination of the amount of funding 
                available for such value-based incentive payments under 
                paragraph (5)(C)(iii).''.
    (b) Conforming Amendments.--
            (1) SNF payment.--Section 1888(e)(4) of the Social Security 
        Act (42 U.S.C. 1395yy(e)(4)) is amended by adding at the end 
        the following new subparagraph:
                    ``(I) Value-based purchasing adjustment.--The 
                adjusted Federal per diem rate under subparagraph (B) 
                is subject to adjustment under paragraphs (5) and (6) 
                of section 1899B(n).''.
            (2) Inpatient rehabilitation facilities.--Section 
        1886(j)(3) of the Social Security Act (42 U.S.C. 1395ww(j)(3)) 
        is amended by adding at the end the following new subparagraph:
                    ``(D) Value-based purchasing adjustment.--The 
                prospective per unit payment rate under this paragraph 
                is subject to adjustment under paragraphs (5) and (6) 
                of section 1899B(n).''.
            (3) Long-term care hospitals.--Section 1886(m) of the 
        Social Security Act (42 U.S.C. 1395ww(m)) is amended by adding 
        at the end the following new paragraph:
            ``(7) Value-based purchasing adjustment.--The standard 
        Federal rate under this subsection, or, if applicable, the 
        applicable site neutral payment rate under paragraph (6), is 
        subject to adjustment under paragraphs (5) and (6) of section 
        1899B(n).''.
            (4) Home health agencies.--Section 1895(b)(3) of the Social 
        Security Act (42 U.S.C. 1395fff(b)(3)) is amended by adding at 
        the end the following new subparagraph:
                    ``(D) Value-based purchasing adjustment.--The 
                standard prospective payment amount (or amounts) under 
                this paragraph is subject to adjustment under 
                paragraphs (5) and (6) of section 1899B(n).''.

SEC. 4. SUNSETTING OF SKILLED NURSING FACILITY VALUE-BASED PURCHASING 
              (SNF VBP) PROGRAM.

    Section 1888(h)(1)(B) of the Social Security Act (42 U.S.C. 
1395yy(h)(1)(B)) is amended--
            (1) in the heading, by inserting ``and to end in fiscal 
        year 2025'' after ``fiscal year 2019''; and
            (2) by inserting ``and before October 1, 2025'' after 
        ``2018''.
                                 <all>
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