I 

116TH CONGRESS 

1ST SESSION H. R. 3406 

To amend title XVIII of the Social Security Act to improve measurements 

under the skilled nursing facility value-based purchasing program under 

the Medicare program, and for other purposes. 

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 

A BILL 

To amend title XVIII of the Social Security Act to improve 

measurements under the skilled nursing facility valuebased purchasing program under the Medicare program, 

and for other purposes. 

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


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1 SECTION 1. 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 Se6 curity 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 

16 for the applicable fiscal year; or 

17 ‘‘(ii) measures that apply to the facil18 ity for the performance period for the ap19 plicable fiscal year.’’; 

20 (2) in paragraph (2)(A)— 

21 (A) by striking ‘‘The Secretary shall 

22 apply’’ 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 

3 1, 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 meas14 ures 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 

19 paragraph: 

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 sub24 section (e)(6) a process to validate such meas25 ures and data, as appropriate, which may be 


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1 similar to 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 Medi9 care & Medicaid Services Program Management 

10 Account for each of fiscal years 2022 through 

11 2024.’’. 

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

13 15, 2021, the Medicare Payment Advisory Commission 

14 shall submit to Congress a report on establishing a proto15 type value-based payment program under a unified pro16 spective payment system for post-acute care services under 

17 the Medicare program under title XVIII of the Social Se18 curity Act (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 

4 such prototype program; and 

5 (2) may— 

6 (A) discuss the possible effects, with re7 spect to the Medicare program, on program 

8 spending, post-acute care providers, patient out9 comes, and other effects determined appropriate 

10 by the Commission; and 

11 (B) include recommendations with respect 

12 to such prototype program, as determined ap13 propriate by the Commission, to Congress and 

14 the Secretary of Health and Human Services. 

Æ 


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