IB 

Union Calendar No. 574 

116TH CONGRESS 

2D SESSION H. R. 3417 

[Report No. 116–691, Part I] 

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

improvements and rural and quality improvements under the Medicare 

program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 21, 2019 

Mr. NEAL (for himself and Mr. BRADY) introduced the following bill; which 

was referred to the Committee on Ways and Means, and in addition to 

the Committee on Energy and Commerce, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

DECEMBER 24, 2020 

Reported from the Committee on Ways and Means with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

DECEMBER 24, 2020 

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on June 21, 2019] 


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A BILL 

To amend title XVIII of the Social Security Act to provide 

for patient improvements and rural and quality improvements under the Medicare program. 


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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Beneficiary Education Tools, Telehealth, and Extenders 

6 Reauthorization Act of 2019’’ or the ‘‘BETTER Act of 

7 2019’’. 

8 (b) TABLE OF CONTENTS.—The table of contents for 

9 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—PATIENT IMPROVEMENTS 

Sec. 101. Beneficiary enrollment notification and eligibility simplification. 

Sec. 102. Extension of funding outreach and assistance for low-income programs. 

Sec. 103. Medicare coverage of certain mental health telehealth services. 

Sec. 104. Requiring prescription drug plan sponsors to include real-time benefit 

information as part of such sponsor’s electronic prescription program under the Medicare program. 

Sec. 105. Transitional coverage and retroactive Medicare part D coverage for certain low-income beneficiaries. 

TITLE II—RURAL AND QUALITY IMPROVEMENTS 

Sec. 201. Medicare GME treatment of hospitals establishing new medical residency training programs after hosting medical resident rotators 

for short durations. 

Sec. 202. Extension of the work geographic index floor under the Medicare program. 

Sec. 203. Extension of funding for quality measure endorsement, input, and selection under Medicare program. 

Sec. 204. Improving measurements under the skilled nursing facility value-based 

purchasing program under the Medicare program. 

10 TITLE I—PATIENT 

11 IMPROVEMENTS 

12 SEC. 101. BENEFICIARY ENROLLMENT NOTIFICATION AND 

13 ELIGIBILITY SIMPLIFICATION. 

14 (a) ELIGIBILITY AND ENROLLMENT NOTICES.— 


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1 (1) AS PART OF SOCIAL SECURITY ACCOUNT

2 STATEMENT FOR INDIVIDUALS ATTAINING AGES 63 TO

3 65.—Section 1143(a) of the Social Security Act (42 

4 U.S.C. 1320b–13(a)) is amended by adding at the end 

5 the following new paragraph: 

6 ‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 

7 ‘‘(A) IN GENERAL.—In the case of statements 

8 provided on or after the date that is 2 years after the 

9 date of the enactment of this paragraph to individ10 uals who are attaining ages 63, 64, and 65, the state11 ment shall also include a notice containing the infor12 mation described in subparagraph (B). 

13 ‘‘(B) CONTENTS OF NOTICE.—The notice re14 quired under subparagraph (A) shall include a clear, 

15 simple explanation of— 

16 ‘‘(i) eligibility for benefits under the Medi17 care program under title XVIII, and in par18 ticular benefits under part B of such title; 

19 ‘‘(ii) the reasons a late enrollment penalty 

20 for failure to timely enroll could be assessed and 

21 how such late enrollment penalty is calculated, 

22 in particular for benefits under part B; 

23 ‘‘(iii) the availability of relief from the late 

24 enrollment penalty and retroactive enrollment 

25 under section 1837(h) (including as such section 


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1 is applied under sections 1818(c) and 

2 1818A(c)(3)), with examples of circumstances 

3 under which such relief may be granted and ex4 amples of circumstances under which such relief 

5 would not be granted; 

6 ‘‘(iv) coordination of benefits (including 

7 primary and secondary coverage scenarios) pur8 suant to section 1862(b), in particular for bene9 fits under part B of such title; and 

10 ‘‘(v) information for populations, such as 

11 residents of Puerto Rico and veterans, for whom 

12 there are special considerations with respect to 

13 enrollment, eligibility, and coordination of bene14 fits under title XVIII. 

15 ‘‘(C) DEVELOPMENT OF NOTICE.— 

16 ‘‘(i) IN GENERAL.—The Secretary, in co17 ordination with the Commissioner of Social Se18 curity, and taking into consideration informa19 tion collected pursuant to clause (ii), shall, not 

20 later than 12 months after the last day of the pe21 riod for the request of information described in 

22 clause (ii), develop the notice to be provided pur23 suant to subparagraph (A). 

24 ‘‘(ii) REQUEST FOR INFORMATION.—Not 

25 later than 6 months after the date of the enactVerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417

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1 ment of this paragraph, the Secretary shall re2 quest written information, including rec3 ommendations, from stakeholders (including the 

4 groups described in subparagraph (D)) on the 

5 information to be included in the notice. 

6 ‘‘(iii) NOTICE IMPROVEMENT.—Beginning 4 

7 years after the date of enactment of this para8 graph, and not less than once every two years 

9 thereafter, the Secretary, in coordination with 

10 the Commissioner of Social Security, shall— 

11 ‘‘(I) review the content of the notice to 

12 be provided under subparagraph (A); 

13 ‘‘(II) solicit recommendations on the 

14 notice through a request for information 

15 process as described in clause (ii); and 

16 ‘‘(III) update and revise such notice as 

17 the Secretary deems appropriate. 

18 ‘‘(D) GROUPS FOR CONSULTATION.—For pur19 poses of subparagraph (C)(ii), the groups described in 

20 this clause include the following: 

21 ‘‘(i) Individuals who are 60 years of age or 

22 older. 

23 ‘‘(ii) Veterans. 

24 ‘‘(iii) Individuals with disabilities. 


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1 ‘‘(iv) Individuals with end stage renal dis2 ease. 

3 ‘‘(v) Low-income individuals and families. 

4 ‘‘(vi) Employers (including human re5 sources professionals). 

6 ‘‘(vii) States (including representatives of 

7 State-run Health Insurance Exchanges, Medicaid 

8 offices, and Departments of Insurance). 

9 ‘‘(viii) State Health Insurance Assistance 

10 Programs. 

11 ‘‘(ix) Health insurers. 

12 ‘‘(x) Health insurance agents and brokers. 

13 ‘‘(xi) Such other groups as specified by the 

14 Secretary. 

15 ‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 

16 Commissioner of Social Security and the Secretary 

17 shall post the notice required under subparagraph (A) 

18 in a prominent location on the public Internet 

19 website of the Social Security Administration and on 

20 the public Internet website of the Centers for Medicare 

21 & Medicaid Services, respectively. 

22 ‘‘(F) REIMBURSEMENT OF COSTS.— 

23 ‘‘(i) IN GENERAL.—Effective for fiscal years 

24 beginning in the year in which the date of enact25 ment of this paragraph occurs, the Commissioner 


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1 of Social Security and the Secretary shall enter 

2 into an agreement which shall provide funding 

3 to cover the administrative costs of the Commis4 sioner’s activities under this paragraph. Such 

5 agreement shall— 

6 ‘‘(I) provide funds to the Commissioner 

7 for the full cost of the Social Security Ad8 ministration’s work related to the imple9 mentation of this paragraph, including any 

10 costs incurred prior to the finalization of 

11 such agreement; 

12 ‘‘(II) provide such funding quarterly 

13 in advance of the applicable quarter based 

14 on estimating methodology agreed to by the 

15 Commissioner and the Secretary; and 

16 ‘‘(III) require an annual accounting 

17 and reconciliation of the actual costs in18 curred and funds provided under this para19 graph. 

20 ‘‘(ii) LIMITATION.—In no case shall funds 

21 from the Social Security Administration’s Limi22 tation on Administrative Expenses be used to 

23 carry out activities related to the implementa24 tion of this paragraph, except as the CommisVerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417

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1 sioner determines is necessary in developing the 

2 agreement under clause (i). 

3 ‘‘(G) NO EFFECT ON OBLIGATION TO MAIL

4 STATEMENTS.—Nothing in this paragraph shall be 

5 construed to relieve the Commissioner of Social Secu6 rity from any requirement under subsection (c), in7 cluding the requirement to mail a statement on an 

8 annual basis to each eligible individual who is not re9 ceiving benefits under title II and for whom a mail10 ing address can be determined through such methods 

11 as the Commissioner determines to be appropriate.’’. 

12 (2) INDIVIDUALS IN MEDICARE WAITING PE13 RIOD.—Title XI of the Social Security Act (42 U.S.C. 

14 1301 et seq.) is amended by inserting after section 

15 1144 the following new section: 

16 ‘‘MEDICARE ENROLLMENT NOTIFICATION AND ELIGIBILITY

17 NOTICES FOR INDIVIDUALS IN MEDICARE WAITING PERIOD

18 ‘‘SEC. 1144A. (a) NOTICES.— 

19 ‘‘(1) IN GENERAL.—The Commissioner of Social 

20 Security shall distribute the notice to be provided 

21 pursuant to section 1143(a)(4), as may be modified 

22 under paragraph (2), to individuals in the 24-month 

23 waiting period under section 226(b). 

24 ‘‘(2) AUTHORITY TO MODIFY NOTICE.—The Sec25 retary, in coordination with the Commissioner of So26 cial Security, may modify the notice to be distributed 


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1 under paragraph (1) as necessary to take into ac2 count the individuals described in such paragraph. 

3 ‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 

4 Commissioner of Social Security and the Secretary 

5 shall post the notice required to be distributed under 

6 paragraph (1) in a prominent location on the public 

7 Internet website of the Social Security Administra8 tion and on the public Internet website of the Centers 

9 for Medicare & Medicaid Services, respectively. 

10 ‘‘(b) TIMING.—Beginning not later than 2 years after 

11 the date of the enactment of this section, a notice required 

12 under subsection (a)(1) shall be mailed to an individual 

13 no less than two times in accordance with the following: 

14 ‘‘(1) The notice shall be provided to such indi15 vidual not later than 3 months prior to the date on 

16 which such individual’s enrollment period begins as 

17 provided under section 1837. 

18 ‘‘(2) The notice shall subsequently be provided to 

19 such individual not later than one month prior to 

20 such date. 

21 ‘‘(c) REIMBURSEMENT OF COSTS.— 

22 ‘‘(1) IN GENERAL.—Effective for fiscal years be23 ginning in the year in which the date of enactment 

24 of this section occurs, the Commissioner of Social Se25 curity and the Secretary shall enter into an agreeVerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417

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1 ment which shall provide funding to cover the admin2 istrative costs of the Commissioner’s activities under 

3 this section. Such agreement shall— 

4 ‘‘(A) provide funds to the Commissioner for 

5 the full cost of the Social Security Administra6 tion’s work related to the implementation of this 

7 section, including any costs incurred prior to the 

8 finalization of such agreement; 

9 ‘‘(B) provide such funding quarterly in ad10 vance of the applicable quarter based on esti11 mating methodology agreed to by the Commis12 sioner and the Secretary; and 

13 ‘‘(C) require an annual accounting and rec14 onciliation of the actual costs incurred and funds 

15 provided under this section. 

16 ‘‘(2) LIMITATION.—In no case shall funds from 

17 the Social Security Administration’s Limitation on 

18 Administrative Expenses be used to carry out activi19 ties related to the implementation of this section, ex20 cept as the Commissioner determines is necessary in 

21 developing the agreement under paragraph (1).’’. 

22 (b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 

23 (1) EFFECTIVE DATE OF COVERAGE.—Section 

24 1838(a) of the Social Security Act (42 U.S.C. 

25 1395q(a)) is amended— 


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1 (A) by amending paragraph (2) to read as 

2 follows: 

3 ‘‘(2)(A) in the case of an individual who enrolls 

4 pursuant to subsection (d) of section 1837 before the 

5 month in which he first satisfies paragraph (1) or (2) 

6 of section 1836, the first day of such month, 

7 ‘‘(B) in the case of an individual who first satis8 fies such paragraph in a month beginning before Jan9 uary 2021 and who enrolls pursuant to such sub10 section (d)— 

11 ‘‘(i) in such month in which he first satis12 fies such paragraph, the first day of the month 

13 following the month in which he so enrolls, 

14 ‘‘(ii) in the month following such month in 

15 which he first satisfies such paragraph, the first 

16 day of the second month following the month in 

17 which he so enrolls, or 

18 ‘‘(iii) more than one month following such 

19 month in which he satisfies such paragraph, the 

20 first day of the third month following the month 

21 in which he so enrolls, 

22 ‘‘(C) in the case of an individual who first satis23 fies such paragraph in a month beginning on or after 

24 January 1, 2021, and who enrolls pursuant to such 

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1 fies such paragraph or in any subsequent month of 

2 his initial enrollment period, the first day of the 

3 month following the month in which he so enrolls, or 

4 ‘‘(D) in the case of an individual who enrolls 

5 pursuant to subsection (e) of section 1837 in a month 

6 beginning— 

7 ‘‘(i) before January 1, 2021, the July 1 fol8 lowing the month in which he so enrolls, or 

9 ‘‘(ii) on or after January 1, 2021, the first 

10 day of the month following the month in which 

11 he so enrolls, or’’; and 

12 (B) by amending paragraph (3) to read as 

13 follows: 

14 ‘‘(3) in the case of an individual who is deemed 

15 to have enrolled— 

16 ‘‘(A) on or before the last day of the third 

17 month of his initial enrollment period, the first 

18 day of the month in which he first meets the ap19 plicable requirements of section 1836 or July 1, 

20 1973, whichever is later, or 

21 ‘‘(B) on or after the first day of the fourth 

22 month of his initial enrollment period, and 

23 where such month begins— 


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1 ‘‘(i) before January 1, 2021, as pre2 scribed under subparagraphs (B)(i), (B)(ii), 

3 (B)(iii), and (D) of paragraph (2), or 

4 ‘‘(ii) on or after January 1, 2021, as 

5 prescribed under paragraph (2)(C).’’. 

6 (2) SPECIAL ENROLLMENT PERIODS FOR EXCEP7 TIONAL CIRCUMSTANCES.— 

8 (A) ENROLLMENT.—Section 1837 of the So9 cial Security Act (42 U.S.C. 1395p) is amended 

10 by adding at the end the following new sub11 section: 

12 ‘‘(m) Beginning January 1, 2021, the Secretary may 

13 establish special enrollment periods in the case of individ14 uals who meet such exceptional conditions as the Secretary 

15 may provide, such as individuals who reside in an area 

16 with an emergency or disaster as determined by the Sec17 retary.’’. 

18 (B) COVERAGE PERIOD.—Section 1838 of 

19 the Social Security Act (42 U.S.C. 1395q) is 

20 amended by adding at the end the following new 

21 subsection: 

22 ‘‘(g) Notwithstanding subsection (a), in the case of an 

23 individual who enrolls during a special enrollment period 

24 pursuant to section 1837(m), the coverage period shall begin 

25 on a date the Secretary provides in a manner consistent 


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1 (to the extent practicable) with protecting continuity of 

2 health benefit coverage.’’. 

3 (C) CONFORMING AMENDMENT.—Section 

4 1839(b) of the Social Security Act (42 U.S.C. 

5 1395r(b)) is amended, in the first sentence, by 

6 striking ‘‘or (l)’’ and inserting ‘‘, (l), or (m)’’. 

7 (3) TECHNICAL CORRECTION.—Section 1839(b) 

8 of the Social Security Act (42 U.S.C. 1395r(b)) is 

9 amended by adding at the end the following new sen10 tence: ‘‘For purposes of determining any increase 

11 under this subsection for individuals whose enroll12 ment occurs on or after January 1, 2021, the second 

13 sentence of this subsection shall be applied by sub14 stituting ‘close of the month’ for ‘close of the enroll15 ment period’ each place it appears.’’. 

16 (4) REPORT.—Not later than January 1, 2021, 

17 the Secretary of Health and Human Services shall 

18 submit to the Committee on Ways and Means and 

19 Committee on Energy and Commerce of the House of 

20 Representatives and the Committee on Finance and 

21 Special Committee on Aging of the Senate a report 

22 including recommendations on how to align existing 

23 Medicare enrollment periods under title XVIII of the 

24 Social Security Act, including the general enrollment 

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1 tion period under the Medicare Advantage program 

2 under part C of such title and under the prescription 

3 drug program under part D of such title. Such rec4 ommendations shall be consistent with the goals of 

5 maximizing coverage continuity and choice and eas6 ing beneficiary transition. 

7 SEC. 102. EXTENSION OF FUNDING OUTREACH AND ASSIST8 ANCE FOR LOW-INCOME PROGRAMS. 

9 (a) ADDITIONAL FUNDING FOR STATE HEALTH INSUR10 ANCE PROGRAMS.—Subsection (a)(1)(B) of section 119 of 

11 the Medicare Improvements for Patients and Providers Act 

12 of 2008 (42 U.S.C. 1395b–3 note), as amended by section 

13 3306 of the Patient Protection and Affordable Care Act 

14 (Public Law 111–148), section 610 of the American Tax15 payer Relief Act of 2012 (Public Law 112–240), section 

16 1110 of the Pathway for SGR Reform Act of 2013 (Public 

17 Law 113–67), section 110 of the Protecting Access to Medi18 care Act of 2014 (Public Law 113–93), section 208 of the 

19 Medicare Access and CHIP Reauthorization Act of 2015 

20 (Public Law 114–10), and section 50207 of the Bipartisan 

21 Budget Act of 2018 (Public Law 115–123), is amended— 

22 (1) in clause (vii), by striking ‘‘and’’ at the end; 

23 (2) in clause (viii), by striking ‘‘and’’ at the end; 

24 (3) in clause (ix), by striking the period at the 

25 end and inserting ‘‘; and’’; and 


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1 (4) by inserting after clause (ix) the following 

2 new clause: 

3 ‘‘(x) for each of fiscal years 2020 

4 through 2022, of $15,000,000.’’. 

5 (b) ADDITIONAL FUNDING FOR AREA AGENCIES ON

6 AGING.—Subsection (b)(1)(B) of such section 119, as so 

7 amended, is amended— 

8 (1) in clause (vii), by striking ‘‘and’’ at the end; 

9 (2) in clause (viii), by striking ‘‘and’’ at the end; 

10 (3) in clause (ix), by striking the period at the 

11 end and inserting ‘‘; and’’; and 

12 (4) by inserting after clause (ix) the following 

13 new clause: 

14 ‘‘(x) for each of fiscal years 2020 

15 through 2022, of $15,000,000.’’. 

16 (c) ADDITIONAL FUNDING FOR AGING AND DISABILITY

17 RESOURCE CENTERS.—Subsection (c)(1)(B) of such section 

18 119, as so amended, is amended— 

19 (1) in clause (vii), by striking ‘‘and’’ at the end; 

20 (2) in clause (viii), by striking ‘‘and’’ at the end; 

21 (3) in clause (ix), by striking the period at the 

22 end and inserting ‘‘; and’’; and 

23 (4) by inserting after clause (ix) the following 

24 new clause: 


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1 ‘‘(x) for each of fiscal years 2020 

2 through 2022, of $5,000,000.’’. 

3 (d) ADDITIONAL FUNDING FOR CONTRACT WITH THE

4 NATIONAL CENTER FOR BENEFITS AND OUTREACH EN5 ROLLMENT.—Subsection (d)(2) of such section 119, as so 

6 amended, is amended— 

7 (1) in clause (vii), by striking ‘‘and’’ at the end; 

8 (2) in clause (viii), by striking ‘‘and’’ at the end; 

9 (3) in clause (ix), by striking the period at the 

10 end and inserting ‘‘; and’’; and 

11 (4) by inserting after clause (ix) the following 

12 new clause: 

13 ‘‘(x) for each of fiscal years 2020 

14 through 2022, of $15,000,000.’’. 

15 SEC. 103. MEDICARE COVERAGE OF CERTAIN MENTAL 

16 HEALTH TELEHEALTH SERVICES. 

17 Section 1834(m) of the Social Security Act (42 U.S.C. 

18 1395m(m)) is amended— 

19 (1) in paragraph (2)(B)(i), by striking ‘‘and 

20 paragraph (6)(C)’’ and inserting ‘‘, paragraph 

21 (6)(C), and paragraph (8)(C)’’; 

22 (2) in paragraph (4)(C)(i), by striking ‘‘and 

23 (7)’’ and inserting ‘‘(7), and (8)’’; 

24 (3) in paragraph (4)(F)(i), by inserting ‘‘serv25 ices identified by CPT codes 90832, 90834, and 90837 


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1 (and as subsequently modified by the Secretary),’’ be2 fore ‘‘and any additional service’’; 

3 (4) in paragraph (6)(A), by striking ‘‘paragraph 

4 (4)(C)’’ and inserting ‘‘paragraph (4)(C)(i)’’; 

5 (5) in paragraph (7), by striking ‘‘The geo6 graphic requirements’’ and inserting ‘‘Subject to 

7 paragraph (8)(D), the geographic requirements’’; and 

8 (6) by adding at the end the following new para9 graph: 

10 ‘‘(8) TREATMENT OF MENTAL HEALTH TELE11 HEALTH SERVICES.— 

12 ‘‘(A) NON-APPLICATION OF ORIGINATING

13 SITE REQUIREMENTS.—The requirements de14 scribed in paragraph (4)(C)(i) shall not apply 

15 with respect to telehealth services furnished on or 

16 after January 1, 2021, that are mental health 

17 telehealth services. Nothing in the previous sen18 tence shall waive any applicable State law re19 quirements. 

20 ‘‘(B) INCLUSION OF CERTAIN SITES.—With 

21 respect to telehealth services described in sub22 paragraph (A), the term ‘originating site’ shall 

23 include the home of the eligible telehealth indi24 vidual at which the individual is located at the 


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1 time the service is furnished via a telecommuni2 cations system. 

3 ‘‘(C) NO ORIGINATING SITE FACILITY

4 FEE.—No facility fee shall be paid under para5 graph (2)(B) to an originating site with respect 

6 to a telehealth service described in subparagraph 

7 (A) if the originating site does not otherwise 

8 meet the requirements for an originating site 

9 under paragraph (4)(C). 

10 ‘‘(D) FACE-TO-FACE INITIAL ASSESSMENT; 

11 REASSESSMENTS.—Payment may not be made 

12 for mental health telehealth services under this 

13 paragraph (if such payment would not otherwise 

14 be allowed under this subsection without applica15 tion of this paragraph or paragraph (7)) fur16 nished to an eligible telehealth individual un17 less— 

18 ‘‘(i) within the 6-month period prior to 

19 the provision of such mental health tele20 health services, the individual receives a 

21 face-to-face clinical assessment, without the 

22 use of telehealth, by a physician described 

23 in subparagraph (F)(i) or a practitioner 

24 described in subparagraph (F)(ii) of the 


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1 needs of such individual for such services; 

2 and 

3 ‘‘(ii) the individual receives a reassess4 ment (at a frequency specified by the Sec5 retary) by a physician so described or a 

6 practitioner so described of the needs of such 

7 individual for such services. 

8 ‘‘(E) MENTAL HEALTH TELEHEALTH SERV9 ICES DEFINED.—For purposes of this paragraph, 

10 the term ‘mental health telehealth service’ means 

11 services identified by CPT codes 90832, 90834, 

12 and 90837 (and as subsequently modified by the 

13 Secretary). 

14 ‘‘(F) PHYSICIAN AND PRACTITIONER DE15 SCRIBED.—For purposes of subparagraph (D): 

16 ‘‘(i) PHYSICIAN.—A physician de17 scribed in this clause is a physician, as de18 fined in section 1861(r)(1). 

19 ‘‘(ii) PRACTITIONER.—A practitioner 

20 described in this clause is a practitioner de21 scribed in any of clauses (i), (iv), or (v) of 

22 section 1842(b)(18)(C).’’. 


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1 SEC. 104. REQUIRING PRESCRIPTION DRUG PLAN SPON2 SORS TO INCLUDE REAL-TIME BENEFIT IN3 FORMATION AS PART OF SUCH SPONSOR’S 

4 ELECTRONIC PRESCRIPTION PROGRAM 

5 UNDER THE MEDICARE PROGRAM. 

6 Section 1860D–4(e)(2) of the Social Security Act (42 

7 U.S.C. 1395w–104(e)(2)) is amended— 

8 (1) in subparagraph (D), by striking ‘‘To the ex9 tent’’ and inserting ‘‘Except as provided in subpara10 graph (F), to the extent’’; and 

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(F) REAL-TIME BENEFIT INFORMATION.— 

14 ‘‘(i) IN GENERAL.—Not later than Jan15 uary 1, 2021, the program shall implement 

16 real-time benefit tools that are capable of 

17 integrating with a prescribing health care 

18 professional’s electronic prescribing or elec19 tronic health record system for the trans20 mission of formulary and benefit informa21 tion in real time to prescribing health care 

22 professionals. With respect to a covered part 

23 D drug, such tools shall be capable of trans24 mitting such information specific to an in25 dividual enrolled in a prescription drug 


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1 plan. Such information shall include the 

2 following: 

3 ‘‘(I) A list of any clinically-ap4 propriate alternatives to such drug in5 cluded in the formulary of such plan. 

6 ‘‘(II) Cost-sharing information for 

7 such drug and such alternatives, in8 cluding a description of any variance 

9 in cost sharing based on the pharmacy 

10 dispensing such drug or such alter11 natives. 

12 ‘‘(III) Information relating to 

13 whether such drug is included in the 

14 formulary of such plan and any prior 

15 authorization or other utilization man16 agement requirements applicable to 

17 such drug and such alternatives so in18 cluded. 

19 ‘‘(ii) ELECTRONIC TRANSMISSION.— 

20 The provisions of subclauses (I) and (II) of 

21 clause (ii) of subparagraph (E) shall apply 

22 to an electronic transmission described in 

23 clause (i) in the same manner as such pro24 visions apply with respect to an electronic 


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1 transmission described in clause (i) of such 

2 subparagraph. 

3 ‘‘(iii) SPECIAL RULE FOR 2021.—The 

4 program shall be deemed to be in compli5 ance with clause (i) for 2021 if the program 

6 complies with the provisions of section 

7 423.160(b)(7) of title 42, Code of Federal 

8 Regulations (or a successor regulation), for 

9 such year.’’. 

10 SEC. 105. TRANSITIONAL COVERAGE AND RETROACTIVE 

11 MEDICARE PART D COVERAGE FOR CERTAIN 

12 LOW-INCOME BENEFICIARIES. 

13 Section 1860D–14 of the Social Security Act (42 

14 U.S.C. 1395w–114) is amended— 

15 (1) by redesignating subsection (e) as subsection 

16 (f); and 

17 (2) by adding after subsection (d) the following 

18 new subsection: 

19 ‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSITION

20 PROGRAM.— 

21 ‘‘(1) IN GENERAL.—Beginning not later than 

22 January 1, 2021, the Secretary shall carry out a pro23 gram to provide transitional coverage for covered part 

24 D drugs for LI NET eligible individuals in accord25 ance with this subsection. 


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1 ‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 

2 For purposes of this subsection, the term ‘LI NET eli3 gible individual’ means a part D eligible individual 

4 who— 

5 ‘‘(A) meets the requirements of clauses (ii) 

6 and (iii) of subsection (a)(3)(A); and 

7 ‘‘(B) has not yet enrolled in a prescription 

8 drug plan or an MA–PD plan, or, who has so 

9 enrolled, but with respect to whom coverage 

10 under such plan has not yet taken effect. 

11 ‘‘(3) TRANSITIONAL COVERAGE.—For purposes of 

12 this subsection, the term ‘transitional coverage’ means 

13 with respect to an LI NET eligible individual— 

14 ‘‘(A) immediate access to covered part D 

15 drugs at the point of sale during the period that 

16 begins on the first day of the month such indi17 vidual is determined to meet the requirements of 

18 clauses (ii) and (iii) of subsection (a)(3)(A) and 

19 ends on the date that coverage under a prescrip20 tion drug plan or MA–PD plan takes effect with 

21 respect to such individual; and 

22 ‘‘(B) in the case of an LI NET eligible indi23 vidual who is a full-benefit dual eligible indi24 vidual (as defined in section 1935(c)(6)) or a re25 cipient of supplemental security income benefits 


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1 under title XVI, retroactive coverage (in the form 

2 of reimbursement of the amounts that would 

3 have been paid under this part had such indi4 vidual been enrolled in a prescription drug plan 

5 or MA–PD plan) of covered part D drugs pur6 chased by such individual during the period that 

7 begins on the date that is the later of— 

8 ‘‘(i) the date that such individual was 

9 first eligible for a low-income subsidy under 

10 this part; or 

11 ‘‘(ii) the date that is 36 months prior 

12 to the date such individual enrolls in a pre13 scription drug plan or MA–PD plan, 

14 and ends on the date that coverage under such 

15 plan takes effect. 

16 ‘‘(4) PROGRAM ADMINISTRATION.— 

17 ‘‘(A) SINGLE POINT OF CONTACT.—The Sec18 retary shall, to the extent feasible, administer the 

19 program under this subsection through a con20 tract with a single program administrator. 

21 ‘‘(B) BENEFIT DESIGN.—The Secretary 

22 shall ensure that the transitional coverage pro23 vided to LI NET eligible individuals under this 

24 subsection— 


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1 ‘‘(i) provides access to all covered part 

2 D drugs under an open formulary; 

3 ‘‘(ii) permits all pharmacies deter4 mined by the Secretary to be in good stand5 ing to process claims under the program; 

6 ‘‘(iii) is consistent with such require7 ments as the Secretary considers necessary 

8 to improve patient safety and ensure appro9 priate dispensing of medication; and 

10 ‘‘(iv) meets such other requirements as 

11 the Secretary may establish. 

12 ‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF

13 THIS TITLE; WAIVER AUTHORITY.— 

14 ‘‘(A) IN GENERAL.—The following provi15 sions shall not apply with respect to the program 

16 under this subsection: 

17 ‘‘(i) Paragraphs (1) and (3)(B) of sec18 tion 1860D–4(a) (relating to dissemination 

19 of general information; availability of infor20 mation on changes in formulary through 

21 the internet). 

22 ‘‘(ii) Subparagraphs (A) and (B) of 

23 section 1860D–4(b)(3) (relating to require24 ments on development and application of 

25 formularies; formulary development). 


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1 ‘‘(iii) Paragraphs (1)(C) and (2) of 

2 section 1860D–4(c) (relating to medication 

3 therapy management program). 

4 ‘‘(B) WAIVER AUTHORITY.—The Secretary 

5 may waive such other requirements of title XI 

6 and this title as may be necessary to carry out 

7 the purposes of the program established under 

8 this subsection.’’. 

9 TITLE II—RURAL AND QUALITY 

10 IMPROVEMENTS 

11 SEC. 201. MEDICARE GME TREATMENT OF HOSPITALS ES12 TABLISHING NEW MEDICAL RESIDENCY 

13 TRAINING PROGRAMS AFTER HOSTING MED14 ICAL RESIDENT ROTATORS FOR SHORT DU15 RATIONS. 

16 (a) REDETERMINATION OF APPROVED FTE RESIDENT

17 AMOUNT.—Section 1886(h)(2)(F) of the Social Security Act 

18 (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

19 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 

20 and 

21 (2) by adding at the end the following: 

22 ‘‘(ii) In applying this subparagraph in the 

23 case of a hospital that trains residents and has 

24 not entered into a GME affiliation agreement (as 

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1 graph (4)(H)(ii)), on or after the date of the en2 actment of this clause, the Secretary shall not es3 tablish an FTE resident amount until such time 

4 as the Secretary determines that the hospital has 

5 trained at least 1.0 full-time-equivalent resident 

6 in an approved medical residency training pro7 gram in a cost reporting period. 

8 ‘‘(iii) In applying this subparagraph for 

9 cost reporting periods beginning on or after the 

10 date of enactment of this clause, in the case of 

11 a hospital that, as of such date of enactment, has 

12 an approved FTE resident amount based on the 

13 training in an approved medical residency pro14 gram or programs of— 

15 ‘‘(I) less than 1.0 full-time-equivalent 

16 resident in any cost reporting period begin17 ning before October 1, 1997, as determined 

18 by the Secretary; or 

19 ‘‘(II) no more than 3.0 full-time-equiv20 alent residents in any cost reporting period 

21 beginning on or after October 1, 1997, and 

22 before the date of the enactment of this 

23 clause, as determined by the Secretary, 

24 in lieu of such FTE resident amount the Sec25 retary shall, in accordance with the methodology 


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1 described in section 413.77(e) of title 42 of the 

2 Code of Federal Regulations (or any successor 

3 regulation), establish a new FTE resident 

4 amount if the hospital trains at least 1.0 full5 time-equivalent resident (in the case of a hos6 pital described in subclause (I)) or more than 3.0 

7 full-time-equivalent residents (in the case of a 

8 hospital described in subclause (II)) in a cost re9 porting period beginning on or after such date of 

10 enactment and before the date that is 5 years 

11 after such date of enactment. 

12 ‘‘(iv) For purposes of carrying out this sub13 paragraph for cost reporting periods beginning 

14 on or after the date of the enactment of this 

15 clause, a hospital shall report full-time-equiva16 lent residents on its cost report for a cost report17 ing period if the hospital trains at least 1.0 full18 time-equivalent residents in an approved med19 ical residency training program or programs in 

20 such period. 

21 ‘‘(v) As appropriate, the Secretary may 

22 consider information from any cost reporting pe23 riod necessary to establish a new FTE resident 

24 amount as described in clause (iii).’’. 


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1 (b) REDETERMINATION OF FTE RESIDENT LIMITA2 TION.—Section 1886(h)(4)(H)(i) of the Social Security Act 

3 (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 

4 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 

5 and 

6 (2) by adding at the end the following: 

7 ‘‘(II) In applying this clause in the 

8 case of a hospital that, on or after the date 

9 of the enactment of this subclause, begins 

10 training residents in a new approved med11 ical residency training program or pro12 grams (as defined by the Secretary), the 

13 Secretary shall not determine a limitation 

14 applicable to the hospital under subpara15 graph (F) until such time as the Secretary 

16 determines that the hospital has trained at 

17 least 1.0 full-time-equivalent resident in 

18 such new approved medical residency train19 ing program or programs in a cost report20 ing period. 

21 ‘‘(III) In applying this clause in the 

22 case of a hospital that, as of the date of the 

23 enactment of this subclause, has a limita24 tion under subparagraph (F), based on a 

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1 ber 1, 1997, of less than 1.0 full-time-equiv2 alent resident, the Secretary shall adjust the 

3 limitation in the manner applicable to a 

4 new approved medical residency training 

5 program if the Secretary determines the 

6 hospital begins training at least 1.0 full7 time-equivalent residents in a program year 

8 beginning on or after such date of enact9 ment and before the date that is 5 years 

10 after such date of enactment. 

11 ‘‘(IV) In applying this clause in the 

12 case of a hospital that, as of the date of the 

13 enactment of this subclause, has a limita14 tion under subparagraph (F), based on a 

15 cost reporting period beginning on or after 

16 October 1, 1997, and before such date of en17 actment, of no more than 3.0 full-time18 equivalent residents, the Secretary shall ad19 just the limitation in the manner applicable 

20 to a new approved medical residency train21 ing program if the Secretary determines the 

22 hospital begins training more than 3.0 full23 time-equivalent residents in a program year 

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1 ment and before the date that is 5 years 

2 after such date of enactment. 

3 ‘‘(V) An adjustment to the limitation 

4 applicable to a hospital made pursuant to 

5 subclause (III) or (IV) shall be made in a 

6 manner consistent with the methodology, as 

7 appropriate, in section 413.79(e) of title 42, 

8 Code of Federal Regulations (or any suc9 cessor regulation). As appropriate, the Sec10 retary may consider information from any 

11 cost reporting periods necessary to make 

12 such an adjustment to the limitation.’’. 

13 (c) TECHNICAL AND CONFORMING AMENDMENTS.— 

14 Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 

15 is amended— 

16 (1) in subsection (d)(5)(B)(viii), by striking 

17 ‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 

18 (2)(F)(iv) and (4)(H) of subsection (h)’’; and 

19 (2) in subsection (h)— 

20 (A) in paragraph (4)(H)(iv), by striking 

21 ‘‘an rural area’’ and inserting ‘‘a rural area’’; 

22 and 

23 (B) in paragraph (7)(E), by striking 

24 ‘‘under this’’ and all that follows through the pe25 riod at the end and inserting the following: 


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1 ‘‘under this paragraph, paragraph (8), clause 

2 (i), (ii), (iii), or (v) of paragraph (2)(F), or 

3 clause (i) or (vi) of paragraph (4)(H).’’. 

4 (d) EFFECTIVE DATE.—The amendments made by this 

5 section shall apply to payment under section 1886 of the 

6 Social Security Act (42 U.S.C. 1395ww) for cost reporting 

7 periods beginning on or after the date of the enactment of 

8 this Act. 

9 SEC. 202. EXTENSION OF THE WORK GEOGRAPHIC INDEX 

10 FLOOR UNDER THE MEDICARE PROGRAM. 

11 Section 1848(e)(1)(E) of the Social Security Act (42 

12 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘2020’’ 

13 and inserting ‘‘2023’’. 

14 SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE 

15 ENDORSEMENT, INPUT, AND SELECTION 

16 UNDER MEDICARE PROGRAM. 

17 (a) IN GENERAL.—Section 1890(d)(2) of the Social Se18 curity Act (42 U.S.C. 1395aaa(d)(2)) is amended— 

19 (1) by striking ‘‘and $7,500,000’’ and inserting 

20 ‘‘$7,500,000’’; and 

21 (2) by striking ‘‘and 2019.’’ and inserting ‘‘and 

22 2019, and $30,000,000 for each of fiscal years 2020 

23 through 2022.’’. 


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1 (b) INPUT FOR REMOVAL OF MEASURES.—Section 

2 1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)) 

3 is amended by inserting after paragraph (3) the following: 

4 ‘‘(4) REMOVAL OF MEASURES.—The entity may 

5 provide input to the Secretary on quality and effi6 ciency measures described in paragraph (7)(B) that 

7 could be considered for removal.’’. 

8 (c) PRIORITIZATION OF MEASURE ENDORSEMENT.— 

9 Section 1890(b) of the Social Security Act (42 U.S.C. 

10 1395aaa(b)) is amended by adding at the end the following: 

11 ‘‘(9) PRIORITIZATION OF MEASURE ENDORSE12 MENT.—The entity— 

13 ‘‘(A) during the period beginning on the 

14 date of the enactment of this paragraph and end15 ing on December 31, 2023, shall prioritize the 

16 endorsement of measures relating to maternal 

17 morbidity and mortality by the entity with a 

18 contract under subsection (a) in connection with 

19 endorsement of measures described in paragraph 

20 (2); and 

21 ‘‘(B) on and after January 1, 2024, may 

22 prioritize the endorsement of such measures by 

23 such entity.’’. 


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1 SEC. 204. IMPROVING MEASUREMENTS UNDER THE 

2 SKILLED NURSING FACILITY VALUE-BASED 

3 PURCHASING PROGRAM UNDER THE MEDI4 CARE PROGRAM. 

5 (a) IN GENERAL.—Section 1888(h) of the Social Secu6 rity Act (42 U.S.C. 1395yy(h)) is amended— 

7 (1) in paragraph (1), by adding at the end the 

8 following new subparagraph: 

9 ‘‘(C) EXCLUSIONS.—With respect to pay10 ments for services furnished on or after October 

11 1, 2021, this subsection shall not apply to a fa12 cility for which there are not a minimum num13 ber (as determined by the Secretary) of— 

14 ‘‘(i) cases for the measures that apply 

15 to the facility for the performance period for 

16 the applicable fiscal year; or 

17 ‘‘(ii) measures that apply to the facil18 ity for the performance period for the appli19 cable fiscal year.’’; 

20 (2) in paragraph (2)(A)— 

21 (A) by striking ‘‘The Secretary shall apply’’ 

22 and inserting ‘‘The Secretary— 

23 ‘‘(i) shall apply’’; 

24 (B) by striking the period at the end and 

25 inserting ‘‘; and’’; and 

26 (C) by adding at the end the following: 


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1 ‘‘(ii) may, with respect to payments 

2 for services furnished on or after October 1, 

3 2022, apply additional measures deter4 mined appropriate by the Secretary, which 

5 may include measures of functional status, 

6 patient safety, care coordination, or patient 

7 experience. 

8 Subject to the succeeding sentence, in the case 

9 that the Secretary applies additional measures 

10 under clause (ii), the Secretary shall consider 

11 and apply, as appropriate, quality measures 

12 specified under section 1899B(c)(1). In no case 

13 may the Secretary apply more than 10 measures 

14 under this subparagraph.’’; 

15 (3) in subparagraph (A) of each of paragraphs 

16 (3) and (4), by striking ‘‘measure’’ and inserting 

17 ‘‘measures’’; and 

18 (4) by adding at the end the following new para19 graph: 

20 ‘‘(12) VALIDATION.— 

21 ‘‘(A) IN GENERAL.—The Secretary shall 

22 apply to the measures applied under this sub23 section and the data submitted under subsection 

24 (e)(6) a process to validate such measures and 

25 data, as appropriate, which may be similar to 


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1 the process specified in section 

2 1886(b)(3)(B)(viii)(XI) for validating inpatient 

3 hospital measures. 

4 ‘‘(B) FUNDING.—For purposes of carrying 

5 out this paragraph, the Secretary shall provide 

6 for the transfer, from the Federal Hospital In7 surance Trust Fund established under section 

8 1817, of $5,000,000 to the Centers for Medicare 

9 & Medicaid Services Program Management Ac10 count for each of fiscal years 2022 through 

11 2024.’’. 

12 (b) REPORT BY MEDPAC.—Not later than March 15, 

13 2021, the Medicare Payment Advisory Commission shall 

14 submit to Congress a report on establishing a prototype 

15 value-based payment program under a unified prospective 

16 payment system for post-acute care services under the Medi17 care program under title XVIII of the Social Security Act 

18 (42 U.S.C. 1395 et seq.). Such report— 

19 (1) shall— 

20 (A) consider design elements such as— 

21 (i) measures that are important to the 

22 Medicare program and to beneficiaries 

23 under such program; 

24 (ii) methodologies for scoring provider 

25 performance and effects on payment; and 


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1 (iii) other elements determined appro2 priate by the Commission; and 

3 (B) analyze the effects of implementing such 

4 prototype program; and 

5 (2) may— 

6 (A) discuss the possible effects, with respect 

7 to the Medicare program, on program spending, 

8 post-acute care providers, patient outcomes, and 

9 other effects determined appropriate by the Com10 mission; and 

11 (B) include recommendations with respect 

12 to such prototype program, as determined appro13 priate by the Commission, to Congress and the 

14 Secretary of Health and Human Services. 


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Union Calendar No. 574 

116TH CONGRESS 

2D SESSION H. R. 3417 

[Report No. 116–691, Part I] 

A BILL 

To amend title XVIII of the Social Security Act to 

gram. quality improvements under the Medicare proprovide for patient improvements and rural and 

DECEMBER 24, 2020 

Reported from the Committee on Ways and Means with 

an amendment 

DECEMBER 24, 2020 

Committee on Energy and Commerce discharged; comState of the Union and ordered to be printed mitted to the Committee of the Whole House on the 


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