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. 
H. R. 2—2 

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. 
H. R. 2—3 

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. 
H. R. 2—4 

‘‘(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 
H. R. 2—5 

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 PROC- ESSES 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: 
H. R. 2—6 

‘‘(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.— 
H. R. 2—7 

‘‘(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)) 
H. R. 2—8 

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 lowvolume 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 
H. R. 2—9 

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. 
H. R. 2—10 

‘‘(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 CAT- EGORIES.— 

‘‘(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 
H. R. 2—11 

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. 
H. R. 2—12 

‘‘(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 ACTIVI- TIES.— ‘‘(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’ 
H. R. 2—13 

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. 
H. R. 2—14 

‘‘(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, peerreviewed 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, 
H. R. 2—15 

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
H. R. 2—16 

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 
H. R. 2—17 

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), 
H. R. 2—18 

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 PERFORM- ANCE 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 
H. R. 2—19 

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— 
H. R. 2—20 

‘‘(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 EXCEP- TIONAL 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 
H. R. 2—21 

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. 
H. R. 2—22 

‘‘(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 
H. R. 2—23 

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: 
H. R. 2—24 

‘‘(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). 
H. R. 2—25 

‘‘(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.— 
H. R. 2—26 

‘‘(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 
H. R. 2—27 

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 MEAS- URES 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 
H. R. 2—28 

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 PROFES- SIONAL 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. 
H. R. 2—29 

(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 Meritbased 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. 
H. R. 2—30 

‘‘(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 physicianfocused 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 
H. R. 2—31 

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 
H. R. 2—32 

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 
H. R. 2—33 

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 
H. R. 2—34 

‘‘(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 
H. R. 2—35 

(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 
H. R. 2—36 

‘‘(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 
H. R. 2—37 

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 valuebased 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 CONDI- TION GROUPS AND CLASSIFICATION CODES.— 
H. R. 2—38 

‘‘(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). 
H. R. 2—39 

‘‘(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 
H. R. 2—40 

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. 
H. R. 2—41 

‘‘(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 PRACTI- TIONERS.—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). 
H. R. 2—42 

‘‘(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 
H. R. 2—43 

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.— 
H. R. 2—44 

‘‘(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. 
H. R. 2—45 

‘‘(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 
H. R. 2—46 

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. 
H. R. 2—47 

(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.— 
H. R. 2—48 

(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 
H. R. 2—49 

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 subpara- graph (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 
H. R. 2—50 

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). 
H. R. 2—51 

(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 
H. R. 2—52 

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 ‘optout 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 
H. R. 2—53 

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’’. 
H. R. 2—54 

(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.— 
H. R. 2—55 

(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) 
H. R. 2—56 

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. 
H. R. 2—57 

(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. 
H. R. 2—58 

‘‘(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— 
H. R. 2—59 

(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.’’. 
H. R. 2—60 

(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. 
H. R. 2—61 

‘‘(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 
H. R. 2—62 

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. 
H. R. 2—63 

‘‘(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— 
H. R. 2—64 

(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: 
H. R. 2—65 

‘‘(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 
H. R. 2—66 

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 
H. R. 2—67 

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 
H. R. 2—68 

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 semiannual 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— 
H. R. 2—69 

(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 
H. R. 2—70 

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— 
H. R. 2—71 

‘‘(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 
H. R. 2—72 

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’’. 
H. R. 2—73 

(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. 
H. R. 2—74 

‘‘(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’’. 
H. R. 2—75 

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 
H. R. 2—76 

(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)— 
H. R. 2—77 

(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 costeffective 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 
H. R. 2—78 

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 IDENTI- FIED.—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). 
H. R. 2—79 

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— 
H. R. 2—80 

(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. 
H. R. 2—81 

‘‘(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. 
H. R. 2—82 

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). 
H. R. 2—83 

‘‘(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. 
H. R. 2—84 

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 
H. R. 2—85 

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.— 
H. R. 2—86 

‘‘(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 prepayment 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 
H. R. 2—87 

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-byservice 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 
H. R. 2—88 

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 
H. R. 2—89 

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. 
H. R. 2—90 

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) 
H. R. 2—91 

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. 
H. R. 2—92 

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 
H. R. 2—93 

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 SelfDetermination 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 
H. R. 2—94 

(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-YouGo Act of 2010. 
H. R. 2—95 

(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.