```

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5273 Engrossed in House (EH)]

<DOC>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
114th CONGRESS
  2d Session
                                H. R. 5273

_______________________________________________________________________

                                 AN ACT

 
    To amend title XVIII of the Social Security Act to provide for 
 regulatory relief under the Medicare program for certain providers of 
 services and suppliers and increased transparency in hospital coding 
              and enrollment data, 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 ``Helping Hospitals 
Improve Patient Care Act of 2016''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
            TITLE I--PROVISIONS RELATING TO MEDICARE PART A

Sec. 101. Development of Medicare study for HCPCS version of MS-DRG 
                            codes for similar hospital services.
Sec. 102. Establishing beneficiary equity in the Medicare hospital 
                            readmission program.
Sec. 103. Five-year extension of the rural community hospital 
                            demonstration program.
Sec. 104. Regulatory relief for LTCHs.
Sec. 105. Savings from IPPS MACRA pay-for through not applying 
                            documentation and coding adjustments.
            TITLE II--PROVISIONS RELATING TO MEDICARE PART B

Sec. 201. Continuing Medicare payment under HOPD prospective payment 
                            system for services furnished by mid-build 
                            off-campus outpatient departments of 
                            providers.
Sec. 202. Treatment of cancer hospitals in off-campus outpatient 
                            department of a provider policy.
Sec. 203. Treatment of eligible professionals in ambulatory surgical 
                            centers for meaningful use and MIPS.
                  TITLE III--OTHER MEDICARE PROVISIONS

Sec. 301. Delay in authority to terminate contracts for Medicare 
                            Advantage plans failing to achieve minimum 
                            quality ratings.
Sec. 302. Requirement for enrollment data reporting for Medicare.
Sec. 303. Updating the Welcome to Medicare package.

            TITLE I--PROVISIONS RELATING TO MEDICARE PART A

SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS VERSION OF MS-DRG 
              CODES FOR SIMILAR HOSPITAL SERVICES.

    Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by adding at the end the following new subsection:
    ``(t) Relating Similar Inpatient and Outpatient Hospital 
Services.--
            ``(1) Development of hcpcs version of ms-drg codes.--
                    ``(A) In general.--Not later than January 1, 2018, 
                the Secretary shall develop HCPCS versions for MS-DRGs 
                that is similar to the ICD-10-PCS for such MS-DRGs such 
                that, to the extent possible, the MS-DRG assignment 
                shall be similar for a claim coded with the HCPCS 
                version as an identical claim coded with a ICD-10-PCS 
                code.
                    ``(B) Coverage of surgical ms-drgs.--In carrying 
                out subparagraph (A), the Secretary shall develop HCPCS 
                versions of MS-DRG codes for not fewer than 10 surgical 
                MS-DRGs.
                    ``(C) Publication and dissemination of the hcpcs 
                versions of ms-drgs.--
                            ``(i) In general.--The Secretary shall 
                        develop a HCPCS MS-DRG definitions manual and 
                        software that is similar to the definitions 
                        manual and software for ICD-10-PCS codes for 
                        such MS-DRGs. The Secretary shall post the 
                        HCPCS MS-DRG definitions manual and software on 
                        the Internet website of the Centers for 
                        Medicare & Medicaid Services. The HCPCS MS-DRG 
                        definitions manual and software shall be in the 
                        public domain and available for use and 
                        redistribution without charge.
                            ``(ii) Use of previous analysis done by 
                        medpac.--In developing the HCPCS MS-DRG 
                        definitions manual and software under clause 
                        (i), the Secretary shall consult with the 
                        Medicare Payment Advisory Commission and shall 
                        consider the analysis done by such Commission 
                        in translating outpatient surgical claims into 
                        inpatient surgical MS-DRGs in preparing chapter 
                        7 (relating to hospital short-stay policy 
                        issues) of its `Medicare and the Health Care 
                        Delivery System' report submitted to Congress 
                        in June 2015.
                    ``(D) Definition and reference.--In this paragraph:
                            ``(i) HCPCS.--The term `HCPCS' means, with 
                        respect to hospital items and services, the 
                        code under the Healthcare Common Procedure 
                        Coding System (HCPCS) (or a successor code) for 
                        such items and services.
                            ``(ii) ICD-10-PCS.--The term `ICD-10-PCS' 
                        means the International Classification of 
                        Diseases, 10th Revision, Procedure Coding 
                        System, and includes a subsequent revision of 
                        such International Classification of Diseases, 
                        Procedure Coding System.''.

SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE HOSPITAL 
              READMISSION PROGRAM.

    (a) Transitional Adjustment for Dual Eligible Population.--Section 
1886(q)(3) of the Social Security Act (42 U.S.C. 1395ww(q)(3)) is 
amended--
            (1) in subparagraph (A), by inserting ``subject to 
        subparagraph (D),'' after ``purposes of paragraph (1),''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Transitional adjustment for dual eligibles.--
                            ``(i) In general.--In determining a 
                        hospital's adjustment factor under this 
                        paragraph for purposes of making payments for 
                        discharges occurring during and after fiscal 
                        year 2019, and before the application of clause 
                        (i) of subparagraph (E), the Secretary shall 
                        assign hospitals to groups (as defined by the 
                        Secretary under clause (ii)) and apply the 
                        applicable provisions of this subsection using 
                        a methodology in a manner that allows for 
                        separate comparison of hospitals within each 
                        such group, as determined by the Secretary.
                            ``(ii) Defining groups.--For purposes of 
                        this subparagraph, the Secretary shall define 
                        groups of hospitals based on their overall 
                        proportion, of the inpatients who are entitled 
                        to, or enrolled for, benefits under part A, who 
                        are full-benefit dual eligible individuals (as 
                        defined in section 1935(c)(6)). In defining 
                        groups, the Secretary shall consult the 
                        Medicare Payment Advisory Commission and may 
                        consider the analysis done by such Commission 
                        in preparing the portion of its report 
                        submitted to Congress in June 2013 relating to 
                        readmissions.
                            ``(iii) Minimizing reporting burden on 
                        hospitals.--In carrying out this subparagraph, 
                        the Secretary shall not impose any additional 
                        reporting requirements on hospitals.
                            ``(iv) Budget neutral design methodology.--
                        The Secretary shall design the methodology to 
                        implement this subparagraph so that the 
                        estimated total amount of reductions in 
                        payments under this subsection equals the 
                        estimated total amount of reductions in 
                        payments that would otherwise occur under this 
                        subsection if this subparagraph did not 
                        apply.''.
    (b) Subsequent Adjustments Based on IMPACT Reports.--Section 
1886(q)(3) of the Social Security Act (42 U.S.C. 1395ww(q)(3)), as 
amended by subsection (a), is further amended by adding at the end the 
following new subparagraph:
                    ``(E) Changes in risk adjustment.--
                            ``(i) Consideration of recommendations in 
                        impact reports.--The Secretary may take into 
                        account the studies conducted and the 
                        recommendations made by the Secretary under 
                        section 2(d)(1) of the IMPACT Act of 2014 
                        (Public Law 113-185; 42 U.S.C. 1395lll note) 
                        with respect to the application under this 
                        subsection of risk adjustment methodologies. 
                        Nothing in this clause shall be construed as 
                        precluding consideration of the use of 
                        groupings of hospitals.''.
    (c) MedPAC Study on Readmissions Program.--The Medicare Payment 
Advisory Commission shall conduct a study to review overall hospital 
readmissions described in section 1886(q)(5)(E) of the Social Security 
Act (42 U.S.C. 1395ww(q)(5)(E)) and whether such readmissions are 
related to any changes in outpatient and emergency services furnished. 
The Commission shall submit to Congress a report on such study in its 
report to Congress in June 2017.
    (d) Addressing Issue of Certain Patients.--Subparagraph (E) of 
section 1886(q)(3) of the Social Security Act (42 U.S.C. 1395ww(q)(3)), 
as added by subsection (b), is further amended by adding at the end the 
following new clause:
                            ``(ii) Consideration of exclusion of 
                        patient cases based on v or other appropriate 
                        codes.--In promulgating regulations to carry 
                        out this subsection with respect to discharges 
                        occurring after fiscal year 2018, the Secretary 
                        may consider the use of V or other ICD-related 
                        codes for removal of a readmission. The 
                        Secretary may consider modifying measures under 
                        this subsection to incorporate V or other ICD-
                        related codes at the same time as other changes 
                        are being made under this subparagraph.''.
    (e) Removal of Certain Readmissions.--Subparagraph (E) of section 
1886(q)(3) of the Social Security Act (42 U.S.C. 1395ww(q)(3)), as 
added by subsection (b) and amended by subsection (d), is further 
amended by adding at the end the following new clause:
                            ``(iii) Removal of certain readmissions.--
                        In promulgating regulations to carry out this 
                        subsection, with respect to discharges 
                        occurring after fiscal year 2018, the Secretary 
                        may consider removal as a readmission of an 
                        admission that is classified within one or more 
                        of the following: transplants, end-stage renal 
                        disease, burns, trauma, psychosis, or substance 
                        abuse. The Secretary may consider modifying 
                        measures under this subsection to remove 
                        readmissions at the same time as other changes 
                        are being made under this subparagraph.''.

SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMUNITY HOSPITAL 
              DEMONSTRATION PROGRAM.

    (a) Extension.--Section 410A of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108-173; 42 
U.S.C. 1395ww note), as amended by sections 3123 and 10313 of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended--
            (1) in subsection (a)(5), by striking ``5-year extension 
        period'' and inserting ``10-year extension period''; and
            (2) in subsection (g)--
                    (A) in the subsection heading, by striking ``Five-
                Year'' and inserting ``Ten-Year'';
                    (B) in paragraph (1), by striking ``additional 5-
                year'' and inserting ``additional 10-year'';
                    (C) by striking ``5-year extension period'' and 
                inserting ``10-year extension period'' each place it 
                appears;
                    (D) in paragraph (4)(B)--
                            (i) in the matter preceding clause (i), by 
                        inserting ``each 5-year period in'' after 
                        ``hospital during''; and
                            (ii) in clause (i), by inserting ``each 
                        applicable 5-year period in'' after ``the first 
                        day of''; and
                    (E) by adding at the end the following new 
                paragraphs:
            ``(5) Other hospitals in demonstration program.--During the 
        second 5 years of the 10-year extension period, the Secretary 
        shall apply the provisions of paragraph (4) to rural community 
        hospitals that are not described in paragraph (4) but are 
        participating in the demonstration program under this section 
        as of December 30, 2014, in a similar manner as such provisions 
        apply to rural community hospitals described in paragraph (4).
            ``(6) Expansion of demonstration program to rural areas in 
        any state.--
                    ``(A) In general.--The Secretary shall, 
                notwithstanding subsection (a)(2) or paragraph (2) of 
                this subsection, not later than 120 days after the date 
                of the enactment of this paragraph, issue a 
                solicitation for applications to select up to the 
                maximum number of additional rural community hospitals 
                located in any State to participate in the 
                demonstration program under this section for the second 
                5 years of the 10-year extension period without 
                exceeding the limitation under paragraph (3) of this 
                subsection.
                    ``(B) Priority.--In determining which rural 
                community hospitals that submitted an application 
                pursuant to the solicitation under subparagraph (A) to 
                select for participation in the demonstration program, 
                the Secretary--
                            ``(i) shall give priority to rural 
                        community hospitals located in one of the 20 
                        States with the lowest population densities (as 
                        determined by the Secretary using the 2015 
                        Statistical Abstract of the United States); and
                            ``(ii) may consider--
                                    ``(I) closures of hospitals located 
                                in rural areas in the State in which 
                                the rural community hospital is located 
                                during the 5-year period immediately 
                                preceding the date of the enactment of 
                                this paragraph; and
                                    ``(II) the population density of 
                                the State in which the rural community 
                                hospital is located.''.
    (b) Change in Timing for Report.--Subsection (e) of such section 
410A is amended--
            (1) by striking ``Not later than 6 months after the 
        completion of the demonstration program under this section'' 
        and inserting ``Not later than August 1, 2018''; and
            (2) by striking ``such program'' and inserting ``the 
        demonstration program under this section''.

SEC. 104. REGULATORY RELIEF FOR LTCHS.

    (a) Technical Change to the Medicare Long-Term Care Hospital 
Moratorium Exception.--
            (1) In general.--Section 114(d)(7) of the Medicare, 
        Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
        note), as amended by sections 3106(b) and 10312(b) of Public 
        Law 111-148, section 1206(b)(2) of the Pathway for SGR Reform 
        Act of 2013 (division B of Public Law 113-67), and section 112 
        of the Protecting Access to Medicare Act of 2014, is amended by 
        striking ``The moratorium under paragraph (1)(A)'' and 
        inserting ``Any moratorium under paragraph (1)''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect as if included in the enactment of section 
        112 of the Protecting Access to Medicare Act of 2014.
    (b) Modification to Medicare Long-Term Care Hospital High Cost 
Outlier Payments.--Section 1886(m) of the Social Security Act (42 
U.S.C. 1395ww(m)) is amended by adding at the end the following new 
paragraph:
            ``(7) Treatment of high cost outlier payments.--
                    ``(A) Adjustment to the standard federal payment 
                rate for estimated high cost outlier payments.--Under 
                the system described in paragraph (1), for fiscal years 
                beginning on or after October 1, 2017, the Secretary 
                shall reduce the standard Federal payment rate as if 
                the estimated aggregate amount of high cost outlier 
                payments for standard Federal payment rate discharges 
                for each such fiscal year would be equal to 8 percent 
                of estimated aggregate payments for standard Federal 
                payment rate discharges for each such fiscal year.
                    ``(B) Limitation on high cost outlier payment 
                amounts.--Notwithstanding subparagraph (A), the 
                Secretary shall set the fixed loss amount for high cost 
                outlier payments such that the estimated aggregate 
                amount of high cost outlier payments made for standard 
                Federal payment rate discharges for fiscal years 
                beginning on or after October 1, 2017, shall be equal 
                to 99.6875 percent of 8 percent of estimated aggregate 
                payments for standard Federal payment rate discharges 
                for each such fiscal year.
                    ``(C) Waiver of budget neutrality.--Any reduction 
                in payments resulting from the application of 
                subparagraph (B) shall not be taken into account in 
                applying any budget neutrality provision under such 
                system.
                    ``(D) No effect on site neutral high cost outlier 
                payment rate.--This paragraph shall not apply with 
                respect to the computation of the applicable site 
                neutral payment rate under paragraph (6).''.

SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH NOT APPLYING 
              DOCUMENTATION AND CODING ADJUSTMENTS.

    Section 7(b)(1)(B)(iii) 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 
122-240) and section 414(1)(B)(iii) of the Medicare Access and CHIP 
Reauthorization Act of 2015 (Public Law 114-10), is amended by striking 
``an increase of 0.5 percentage points for discharges occurring during 
each of fiscal years 2018 through 2023'' and inserting ``an increase of 
0.4590 percentage points for discharges occurring during fiscal year 
2018 and 0.5 percentage points for discharges occurring during each of 
fiscal years 2019 through 2023''.

            TITLE II--PROVISIONS RELATING TO MEDICARE PART B

SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD PROSPECTIVE PAYMENT 
              SYSTEM FOR SERVICES FURNISHED BY MID-BUILD OFF-CAMPUS 
              OUTPATIENT DEPARTMENTS OF PROVIDERS.

    (a) In General.--Section 1833(t)(21) of the Social Security Act (42 
U.S.C. 1395l(t)(21)) is amended--
            (1) in subparagraph (B)--
                    (A) in clause (i), by striking ``clause (ii)'' and 
                inserting ``the subsequent provisions of this 
                subparagraph''; and
                    (B) by adding at the end the following new clauses:
                            ``(iii) Deemed treatment for 2017.--For 
                        purposes of applying clause (ii) with respect 
                        to applicable items and services furnished 
                        during 2017, a department of a provider (as so 
                        defined) not described in such clause is deemed 
                        to be billing under this subsection with 
                        respect to covered OPD services furnished prior 
                        to November 2, 2015, if the Secretary received 
                        from the provider prior to December 2, 2015, an 
                        attestation (pursuant to section 413.65(b)(3) 
                        of title 42 of the Code of Federal Regulations) 
                        that such department was a department of a 
                        provider (as so defined).
                            ``(iv) Alternative exception beginning with 
                        2018.--For purposes of paragraph (1)(B)(v) and 
                        this paragraph with respect to applicable items 
                        and services furnished during 2018 or a 
                        subsequent year, the term `off-campus 
                        outpatient department of a provider' also shall 
                        not include a department of a provider (as so 
                        defined) that is not described in clause (ii) 
                        if--
                                    ``(I) the Secretary receives from 
                                the provider an attestation (pursuant 
                                to such section 413.65(b)(3)) not later 
                                than December 31, 2016 (or, if later, 
                                60 days after the date of the enactment 
                                of this clause), that such department 
                                met the requirements of a department of 
                                a provider specified in section 413.65 
                                of title 42 of the Code of Federal 
                                Regulations;
                                    ``(II) the provider includes such 
                                department as part of the provider on 
                                its enrollment form in accordance with 
                                the enrollment process under section 
                                1866(j); and
                                    ``(III) the department met the mid-
                                build requirement of clause (v) and the 
                                Secretary receives, not later than 60 
                                days after the date of the enactment of 
                                this clause, from the chief executive 
                                officer or chief operating officer of 
                                the provider a written certification 
                                that the department met such 
                                requirement.
                            ``(v) Mid-build requirement described.--The 
                        mid-build requirement of this clause is, with 
                        respect to a department of a provider, that 
                        before November 2, 2015, the provider had a 
                        binding written agreement with an outside 
                        unrelated party for the actual construction of 
                        such department.
                            ``(vii) Audit.--Not later than December 31, 
                        2018, the Secretary shall audit the compliance 
                        with requirements of clause (iv) with respect 
                        to each department of a provider to which such 
                        clause applies. If the Secretary finds as a 
                        result of an audit under this clause that the 
                        applicable requirements were not met with 
                        respect to such department, the department 
                        shall not be excluded from the term `off-campus 
                        outpatient department of a provider' under such 
                        clause.
                            ``(viii) Implementation.--For purposes of 
                        implementing clauses (iii) through (vii):
                                    ``(I) Notwithstanding any other 
                                provision of law, the Secretary may 
                                implement such clauses by program 
                                instruction or otherwise.
                                    ``(II) Subchapter I of chapter 35 
                                of title 44, United States Code, shall 
                                not apply.
                                    ``(III) For purposes of carrying 
                                out this subparagraph with respect to 
                                clauses (iii) and (iv) (and clause 
                                (vii) insofar as it relates to clause 
                                (iv)), $10,000,000 shall be available 
                                from the Federal Supplementary Medical 
                                Insurance Trust Fund under section 
                                1841, to remain available until 
                                December 31, 2018.''; and
            (2) in subparagraph (E), by adding at the end the following 
        new clause:
                            ``(iv) The determination of an audit under 
                        subparagraph (B)(vii).''.
    (b) Effective Date.--The amendments made by this section shall be 
effective as if included in the enactment of section 603 of the 
Bipartisan Budget Act of 2015 (Public Law 114-74).

SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAMPUS OUTPATIENT 
              DEPARTMENT OF A PROVIDER POLICY.

    (a) In General.--Section 1833(t)(21)(B) of the Social Security Act 
(42 U.S.C. 1395l(t)(21)(B)), as amended by section 201(a), is amended--
            (1) by inserting after clause (v) the following new clause:
                            ``(vi) Exclusion for certain cancer 
                        hospitals.--For purposes of paragraph (1)(B)(v) 
                        and this paragraph with respect to applicable 
                        items and services furnished during 2017 or a 
                        subsequent year, the term `off-campus 
                        outpatient department of a provider' also shall 
                        not include a department of a provider (as so 
                        defined) that is not described in clause (ii) 
                        if the provider is a hospital described in 
                        section 1886(d)(1)(B)(v) and--
                                    ``(I) in the case of a department 
                                that met the requirements of section 
                                413.65 of title 42 of the Code of 
                                Federal Regulations after November 1, 
                                2015, and before the date of the 
                                enactment of this clause, the Secretary 
                                receives from the provider an 
                                attestation that such department met 
                                such requirements not later than 60 
                                days after such date of enactment; or
                                    ``(II) in the case of a department 
                                that meets such requirements after such 
                                date of enactment, the Secretary 
                                receives from the provider an 
                                attestation that such department meets 
                                such requirements not later than 60 
                                days after the date such requirements 
                                are first met with respect to such 
                                department.'';
            (2) in clause (vii), by inserting after the first sentence 
        the following: ``Not later than 2 years after the date the 
        Secretary receives an attestation under clause (vi) relating to 
        compliance of a department of a provider with requirements 
        referred to in such clause, the Secretary shall audit the 
        compliance with such requirements with respect to the 
        department.''; and
            (3) in clause (viii)(III), by adding at the end the 
        following: ``For purposes of carrying out this subparagraph 
        with respect to clause (vi) (and clause (vii) insofar as it 
        relates to such clause), $2,000,000 shall be available from the 
        Federal Supplementary Medical Insurance Trust Fund under 
        section 1841, to remain available until expended.''.
    (b) Offsetting Savings.--Section 1833(t)(18) of the Social Security 
Act (42 U.S.C. 1395l(t)(18)) is amended--
            (1) in subparagraph (B), by inserting ``, subject to 
        subparagraph (C),'' after ``shall''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Target pcr adjustment.--In applying section 
                419.43(i) of title 42 of the Code of Federal 
                Regulations to implement the appropriate adjustment 
                under this paragraph for services furnished on or after 
                January 1, 2018, the Secretary shall use a target PCR 
                that is 1.0 percentage points less than the target PCR 
                that would otherwise apply. In addition to the 
                percentage point reduction under the previous sentence, 
                the Secretary may consider making an additional 
                percentage point reduction to such target PCR that 
                takes into account payment rates for applicable items 
                and services described in paragraph (21)(C) other than 
                for services furnished by hospitals described in 
                section 1886(d)(1)(B)(v). In making any budget 
                neutrality adjustments under this subsection for 2018 
                or a subsequent year, the Secretary shall not take into 
                account the reduced expenditures that result from the 
                application of this subparagraph.''.
    (c) Effective Date.--The amendments made by this section shall be 
effective as if included in the enactment of section 603 of the 
Bipartisan Budget Act of 2015 (Public Law 114-74).

SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN AMBULATORY SURGICAL 
              CENTERS FOR MEANINGFUL USE AND MIPS.

    (a) In General.--Section 1848(a)(7)(D) of the Social Security Act 
(42 U.S.C. 1395w-4(a)(7)(D)) is amended--
            (1) by striking ``hospital-based eligible professionals'' 
        and all that follows through ``No payment'' and inserting the 
        following: ``hospital-based and ambulatory surgical center-
        based eligible professionals.--
                            ``(i) Hospital-based.--No payment''; and
            (2) by adding at the end the following new clauses:
                            ``(ii) Ambulatory surgical center-based.--
                        Subject to clause (iv), no payment adjustment 
                        may be made under subparagraph (A) for 2017 and 
                        2018 in the case of an eligible professional 
                        with respect to whom substantially all of the 
                        covered professional services furnished by such 
                        professional are furnished in an ambulatory 
                        surgical center.
                            ``(iii) Determination.--The determination 
                        of whether an eligible professional is an 
                        eligible professional described in clause (ii) 
                        may be made on the basis of--
                                    ``(I) the site of service (as 
                                defined by the Secretary); or
                                    ``(II) an attestation submitted by 
                                the eligible professional.
                        Determinations made under subclauses (I) and 
                        (II) shall be made without regard to any 
                        employment or billing arrangement between the 
                        eligible professional and any other supplier or 
                        provider of services.
                            ``(iv) Sunset.--Clause (ii) shall no longer 
                        apply as of the first year that begins more 
                        than 3 years after the date on which the 
                        Secretary determines, through notice and 
                        comment rulemaking, that certified EHR 
                        technology applicable to the ambulatory 
                        surgical center setting is available.''.
    (b) Continued Application of Certain Provisions Under MIPS.--
Section 1848(o)(2)(D) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(D)) is amended by adding at the end the following new sentence: 
``The provisions of subparagraphs (B) and (D) of subsection (a)(7), 
including the application of clause (iv) of such subparagraph (D), 
shall apply to assessments of MIPS eligible professionals under 
subsection (q) with respect to the performance category described in 
subsection (q)(2)(A)(iv) in a manner similar to the manner in which 
such provisions apply with respect to payment adjustments made under 
subsection (a)(7)(A).''.

                  TITLE III--OTHER MEDICARE PROVISIONS

SEC. 301. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR MEDICARE 
              ADVANTAGE PLANS FAILING TO ACHIEVE MINIMUM QUALITY 
              RATINGS.

    (a) Findings.--Consistent with the studies provided under the 
IMPACT Act of 2014 (Public Law 113-185), it is the intent of Congress--
            (1) to continue to study and request input on the effects 
        of socioeconomic status and dual-eligible populations on the 
        Medicare Advantage STARS rating system before reforming such 
        system with the input of stakeholders; and
            (2) pending the results of such studies and input, to 
        provide for a temporary delay in authority of the Centers for 
        Medicare & Medicaid Services (CMS) to terminate Medicare 
        Advantage plan contracts solely on the basis of performance of 
        plans under the STARS rating system.
    (b) Delay in MA Contract Termination Authority for Plans Failing To 
Achieve Minimum Quality Ratings.--Section 1857(h) of the Social 
Security Act (42 U.S.C. 1395w-27(h)) is amended by adding at the end 
the following new paragraph:
            ``(3) Delay in contract termination authority for plans 
        failing to achieve minimum quality rating.--During the period 
        beginning on the date of the enactment of this paragraph and 
        through the end of plan year 2018, the Secretary may not 
        terminate a contract under this section with respect to the 
        offering of an MA plan by a Medicare Advantage organization 
        solely because the MA plan has failed to achieve a minimum 
        quality rating under the 5-star rating system under section 
        1853(o)(4).''.

SEC. 302. REQUIREMENT FOR ENROLLMENT DATA REPORTING FOR MEDICARE.

    Section 1874 of the Social Security Act (42 U.S.C. 1395kk) is 
amended by adding at the end the following new subsection:
    ``(g) Requirement for Enrollment Data Reporting.--
            ``(1) In general.--Each year (beginning with 2016), the 
        Secretary shall submit to the Committees on Ways and Means and 
        Energy and Commerce of the House of Representatives and the 
        Committee on Finance of the Senate a report on Medicare 
        enrollment data (and, in the case of part A, on data on 
        individuals receiving benefits under such part) as of a date in 
        such year specified by the Secretary. Such data shall be 
        presented--
                    ``(A) by Congressional district and State; and
                    ``(B) in a manner that provides for such data based 
                on--
                            ``(i) fee-for-service enrollment (as 
                        defined in paragraph (2));
                            ``(ii) enrollment under part C (including 
                        separate for aggregate enrollment in MA-PD 
                        plans and aggregate enrollment in MA plans that 
                        are not MA-PD plans); and
                            ``(iii) enrollment under part D.
            ``(2) Fee-for-service enrollment defined.--For purpose of 
        paragraph (1)(B)(i), the term `fee-for-service enrollment' 
        means aggregate enrollment (including receipt of benefits other 
        than through enrollment) under--
                    ``(A) part A only;
                    ``(B) part B only; and
                    ``(C) both part A and part B.''.

SEC. 303. UPDATING THE WELCOME TO MEDICARE PACKAGE.

    (a) In General.--Not later than 12 months after the last day of the 
period for the request of information described in subsection (b), the 
Secretary of Health and Human Services shall, taking into consideration 
information collected pursuant to subsection (b), update the 
information included in the Welcome to Medicare package to include 
information, presented in a clear and simple manner, about options for 
receiving benefits under the Medicare program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.), including through the 
original medicare fee-for-service program under parts A and B of such 
title (42 U.S.C. 1395c et seq., 42 U.S.C. 1395j et seq.), Medicare 
Advantage plans under part C of such title (42 U.S.C. 1395w-21 et 
seq.), and prescription drug plans under part D of such title (42 
U.S.C. 1395w-101 et seq.)). The Secretary shall make subsequent updates 
to the information included in the Welcome to Medicare package as 
appropriate.
    (b) Request for Information.--Not later than 6 months after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services shall request information, including recommendations, from 
stakeholders (including patient advocates, issuers, and employers) on 
information included in the Welcome to Medicare package, including 
pertinent data and information regarding enrollment and coverage for 
Medicare eligible individuals.

            Passed the House of Representatives June 7, 2016.

            Attest:

                                                                 Clerk.
114th CONGRESS

  2d Session

                               H. R. 5273

_______________________________________________________________________

                                 AN ACT

    To amend title XVIII of the Social Security Act to provide for 
 regulatory relief under the Medicare program for certain providers of 
 services and suppliers and increased transparency in hospital coding 
              and enrollment data, and for other purposes.
```