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. 

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. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Helping Hospitals Improve Patient Care Act of 2016’’. 

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

5 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. 
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1 TITLE I—PROVISIONS RELATING 

2 TO MEDICARE PART A 

3 SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS 

4 VERSION OF MS–DRG CODES FOR SIMILAR 

5 HOSPITAL SERVICES. 

6 Section 1886 of the Social Security Act (42 U.S.C. 

7 1395ww) is amended by adding at the end the following 

8 new subsection: 

9 ‘‘(t) RELATING SIMILAR INPATIENT AND OUT10 PATIENT HOSPITAL SERVICES.— 

11 ‘‘(1) DEVELOPMENT OF HCPCS VERSION OF

12 MS–DRG CODES.— 

13 ‘‘(A) IN GENERAL.—Not later than Janu14 ary 1, 2018, the Secretary shall develop 

15 HCPCS versions for MS–DRGs that is similar 

16 to the ICD–10–PCS for such MS–DRGs such 

17 that, to the extent possible, the MS–DRG as18 signment shall be similar for a claim coded with 

19 the HCPCS version as an identical claim coded 

20 with a ICD–10–PCS code. 

21 ‘‘(B) COVERAGE OF SURGICAL MS–DRGS.— 

22 In carrying out subparagraph (A), the Sec23 retary shall develop HCPCS versions of MS– 

24 DRG codes for not fewer than 10 surgical MS– 

25 DRGs. 
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1 ‘‘(C) PUBLICATION AND DISSEMINATION

2 OF THE HCPCS VERSIONS OF MS–DRGS.— 

3 ‘‘(i) IN GENERAL.—The Secretary 

4 shall develop a HCPCS MS–DRG defini5 tions manual and software that is similar 

6 to the definitions manual and software for 

7 ICD–10–PCS codes for such MS–DRGs. 

8 The Secretary shall post the HCPCS MS– 

9 DRG definitions manual and software on 

10 the Internet website of the Centers for 

11 Medicare & Medicaid Services. The 

12 HCPCS MS–DRG definitions manual and 

13 software shall be in the public domain and 

14 available for use and redistribution without 

15 charge. 

16 ‘‘(ii) USE OF PREVIOUS ANALYSIS

17 DONE BY MEDPAC.—In developing the 

18 HCPCS MS–DRG definitions manual and 

19 software under clause (i), the Secretary 

20 shall consult with the Medicare Payment 

21 Advisory Commission and shall consider 

22 the analysis done by such Commission in 

23 translating outpatient surgical claims into 

24 inpatient surgical MS–DRGs in preparing 

25 chapter 7 (relating to hospital short-stay 
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1 policy issues) of its ‘Medicare and the 

2 Health Care Delivery System’ report sub3 mitted to Congress in June 2015. 

4 ‘‘(D) DEFINITION AND REFERENCE.—In 

5 this paragraph: 

6 ‘‘(i) HCPCS.—The term ‘HCPCS’ 

7 means, with respect to hospital items and 

8 services, the code under the Healthcare 

9 Common Procedure Coding System 

10 (HCPCS) (or a successor code) for such 

11 items and services. 

12 ‘‘(ii) ICD–10–PCS.—The term ‘ICD– 

13 10–PCS’ means the International Classi14 fication of Diseases, 10th Revision, Proce15 dure Coding System, and includes a subse16 quent revision of such International Classi17 fication of Diseases, Procedure Coding 

18 System.’’. 

19 SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE 

20 MEDICARE HOSPITAL READMISSION PRO21 GRAM. 

22 (a) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGI23 BLE POPULATION.—Section 1886(q)(3) of the Social Se24 curity Act (42 U.S.C. 1395ww(q)(3)) is amended— 
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1 (1) in subparagraph (A), by inserting ‘‘subject 

2 to subparagraph (D),’’ after ‘‘purposes of paragraph 

3 (1),’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(D) TRANSITIONAL ADJUSTMENT FOR

7 DUAL ELIGIBLES.— 

8 ‘‘(i) IN GENERAL.—In determining a 

9 hospital’s adjustment factor under this 

10 paragraph for purposes of making pay11 ments for discharges occurring during and 

12 after fiscal year 2019, and before the ap13 plication of clause (i) of subparagraph (E), 

14 the Secretary shall assign hospitals to 

15 groups (as defined by the Secretary under 

16 clause (ii)) and apply the applicable provi17 sions of this subsection using a method18 ology in a manner that allows for separate 

19 comparison of hospitals within each such 

20 group, as determined by the Secretary. 

21 ‘‘(ii) DEFINING GROUPS.—For pur22 poses of this subparagraph, the Secretary 

23 shall define groups of hospitals based on 

24 their overall proportion, of the inpatients 

25 who are entitled to, or enrolled for, bene-
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1 fits under part A, who are full-benefit dual 

2 eligible individuals (as defined in section 

3 1935(c)(6)). In defining groups, the Sec4 retary shall consult the Medicare Payment 

5 Advisory Commission and may consider 

6 the analysis done by such Commission in 

7 preparing the portion of its report sub8 mitted to Congress in June 2013 relating 

9 to readmissions. 

10 ‘‘(iii) MINIMIZING REPORTING BUR11 DEN ON HOSPITALS.—In carrying out this 

12 subparagraph, the Secretary shall not im13 pose any additional reporting requirements 

14 on hospitals. 

15 ‘‘(iv) BUDGET NEUTRAL DESIGN

16 METHODOLOGY.—The Secretary shall de17 sign the methodology to implement this 

18 subparagraph so that the estimated total 

19 amount of reductions in payments under 

20 this subsection equals the estimated total 

21 amount of reductions in payments that 

22 would otherwise occur under this sub23 section if this subparagraph did not 

24 apply.’’. 
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1 (b) SUBSEQUENT ADJUSTMENTS BASED ON IM2 PACT REPORTS.—Section 1886(q)(3) of the Social Secu3 rity Act (42 U.S.C. 1395ww(q)(3)), as amended by sub4 section (a), is further amended by adding at the end the 

5 following new subparagraph: 

6 ‘‘(E) CHANGES IN RISK ADJUSTMENT.— 

7 ‘‘(i) CONSIDERATION OF REC8 OMMENDATIONS IN IMPACT REPORTS.— 

9 The Secretary may take into account the 

10 studies conducted and the recommenda11 tions made by the Secretary under section 

12 2(d)(1) of the IMPACT Act of 2014 (Pub13 lic Law 113–185; 42 U.S.C. 1395lll note) 

14 with respect to the application under this 

15 subsection of risk adjustment methodolo16 gies. Nothing in this clause shall be con17 strued as precluding consideration of the 

18 use of groupings of hospitals.’’. 

19 (c) MEDPAC STUDY ON READMISSIONS PROGRAM.— 

20 The Medicare Payment Advisory Commission shall con21 duct a study to review overall hospital readmissions de22 scribed in section 1886(q)(5)(E) of the Social Security Act 

23 (42 U.S.C. 1395ww(q)(5)(E)) and whether such readmis24 sions are related to any changes in outpatient and emer25 gency services furnished. The Commission shall submit to 
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1 Congress a report on such study in its report to Congress 

2 in June 2017. 

3 (d) ADDRESSING ISSUE OF CERTAIN PATIENTS.— 

4 Subparagraph (E) of section 1886(q)(3) of the Social Se5 curity Act (42 U.S.C. 1395ww(q)(3)), as added by sub6 section (b), is further amended by adding at the end the 

7 following new clause: 

8 ‘‘(ii) CONSIDERATION OF EXCLUSION

9 OF PATIENT CASES BASED ON V OR OTHER

10 APPROPRIATE CODES.—In promulgating 

11 regulations to carry out this subsection 

12 with respect to discharges occurring after 

13 fiscal year 2018, the Secretary may con14 sider the use of V or other ICD-related 

15 codes for removal of a readmission. The 

16 Secretary may consider modifying meas17 ures under this subsection to incorporate V 

18 or other ICD-related codes at the same 

19 time as other changes are being made 

20 under this subparagraph.’’. 

21 (e) REMOVAL OF CERTAIN READMISSIONS.—Sub22 paragraph (E) of section 1886(q)(3) of the Social Security 

23 Act (42 U.S.C. 1395ww(q)(3)), as added by subsection (b) 

24 and amended by subsection (d), is further amended by 

25 adding at the end the following new clause: 
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1 ‘‘(iii) REMOVAL OF CERTAIN RE2 ADMISSIONS.—In promulgating regulations 

3 to carry out this subsection, with respect 

4 to discharges occurring after fiscal year 

5 2018, the Secretary may consider removal 

6 as a readmission of an admission that is 

7 classified within one or more of the fol8 lowing: transplants, end-stage renal dis9 ease, burns, trauma, psychosis, or sub10 stance abuse. The Secretary may consider 

11 modifying measures under this subsection 

12 to remove readmissions at the same time 

13 as other changes are being made under 

14 this subparagraph.’’. 

15 SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMU16 NITY HOSPITAL DEMONSTRATION PROGRAM. 

17 (a) EXTENSION.—Section 410A of the Medicare Pre18 scription Drug, Improvement, and Modernization Act of 

19 2003 (Public Law 108–173; 42 U.S.C. 1395ww note), as 

20 amended by sections 3123 and 10313 of the Patient Pro21 tection and Affordable Care Act (Public Law 111–148), 

22 is amended— 

23 (1) in subsection (a)(5), by striking ‘‘5-year ex24 tension period’’ and inserting ‘‘10-year extension pe25 riod’’; and 
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1 (2) in subsection (g)— 

2 (A) in the subsection heading, by striking 

3 ‘‘FIVE-YEAR’’ and inserting ‘‘TEN-YEAR’’; 

4 (B) in paragraph (1), by striking ‘‘addi5 tional 5-year’’ and inserting ‘‘additional 10- 

6 year’’; 

7 (C) by striking ‘‘5-year extension period’’ 

8 and inserting ‘‘10-year extension period’’ each 

9 place it appears; 

10 (D) in paragraph (4)(B)— 

11 (i) in the matter preceding clause (i), 

12 by inserting ‘‘each 5-year period in’’ after 

13 ‘‘hospital during’’; and 

14 (ii) in clause (i), by inserting ‘‘each 

15 applicable 5-year period in’’ after ‘‘the first 

16 day of’’; and 

17 (E) by adding at the end the following new 

18 paragraphs: 

19 ‘‘(5) OTHER HOSPITALS IN DEMONSTRATION

20 PROGRAM.—During the second 5 years of the 10- 

21 year extension period, the Secretary shall apply the 

22 provisions of paragraph (4) to rural community hos23 pitals that are not described in paragraph (4) but 

24 are participating in the demonstration program 

25 under this section as of December 30, 2014, in a 
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1 similar manner as such provisions apply to rural 

2 community hospitals described in paragraph (4). 

3 ‘‘(6) EXPANSION OF DEMONSTRATION PROGRAM

4 TO RURAL AREAS IN ANY STATE.— 

5 ‘‘(A) IN GENERAL.—The Secretary shall, 

6 notwithstanding subsection (a)(2) or paragraph 

7 (2) of this subsection, not later than 120 days 

8 after the date of the enactment of this para9 graph, issue a solicitation for applications to se10 lect up to the maximum number of additional 

11 rural community hospitals located in any State 

12 to participate in the demonstration program 

13 under this section for the second 5 years of the 

14 10-year extension period without exceeding the 

15 limitation under paragraph (3) of this sub16 section. 

17 ‘‘(B) PRIORITY.—In determining which 

18 rural community hospitals that submitted an 

19 application pursuant to the solicitation under 

20 subparagraph (A) to select for participation in 

21 the demonstration program, the Secretary— 

22 ‘‘(i) shall give priority to rural com23 munity hospitals located in one of the 20 

24 States with the lowest population densities 

25 (as determined by the Secretary using the 
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1 2015 Statistical Abstract of the United 

2 States); and 

3 ‘‘(ii) may consider— 

4 ‘‘(I) closures of hospitals located 

5 in rural areas in the State in which 

6 the rural community hospital is lo7 cated during the 5-year period imme8 diately preceding the date of the en9 actment of this paragraph; and 

10 ‘‘(II) the population density of 

11 the State in which the rural commu12 nity hospital is located.’’. 

13 (b) CHANGE IN TIMING FOR REPORT.—Subsection 

14 (e) of such section 410A is amended— 

15 (1) by striking ‘‘Not later than 6 months after 

16 the completion of the demonstration program under 

17 this section’’ and inserting ‘‘Not later than August 

18 1, 2018’’; and 

19 (2) by striking ‘‘such program’’ and inserting 

20 ‘‘the demonstration program under this section’’. 

21 SEC. 104. REGULATORY RELIEF FOR LTCHS. 

22 (a) TECHNICAL CHANGE TO THE MEDICARE LONG23 TERM CARE HOSPITAL MORATORIUM EXCEPTION.— 

24 (1) IN GENERAL.—Section 114(d)(7) of the 

25 Medicare, Medicaid, and SCHIP Extension Act of 
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1 2007 (42 U.S.C. 1395ww note), as amended by sec2 tions 3106(b) and 10312(b) of Public Law 111–148, 

3 section 1206(b)(2) of the Pathway for SGR Reform 

4 Act of 2013 (division B of Public Law 113–67), and 

5 section 112 of the Protecting Access to Medicare Act 

6 of 2014, is amended by striking ‘‘The moratorium 

7 under paragraph (1)(A)’’ and inserting ‘‘Any mora8 torium under paragraph (1)’’. 

9 (2) EFFECTIVE DATE.—The amendment made 

10 by paragraph (1) shall take effect as if included in 

11 the enactment of section 112 of the Protecting Ac12 cess to Medicare Act of 2014. 

13 (b) MODIFICATION TO MEDICARE LONG-TERM CARE

14 HOSPITAL HIGH COST OUTLIER PAYMENTS.—Section 

15 1886(m) of the Social Security Act (42 U.S.C. 

16 1395ww(m)) is amended by adding at the end the fol17 lowing new paragraph: 

18 ‘‘(7) TREATMENT OF HIGH COST OUTLIER PAY19 MENTS.— 

20 ‘‘(A) ADJUSTMENT TO THE STANDARD

21 FEDERAL PAYMENT RATE FOR ESTIMATED

22 HIGH COST OUTLIER PAYMENTS.—Under the 

23 system described in paragraph (1), for fiscal 

24 years beginning on or after October 1, 2017, 

25 the Secretary shall reduce the standard Federal 
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1 payment rate as if the estimated aggregate 

2 amount of high cost outlier payments for stand3 ard Federal payment rate discharges for each 

4 such fiscal year would be equal to 8 percent of 

5 estimated aggregate payments for standard 

6 Federal payment rate discharges for each such 

7 fiscal year. 

8 ‘‘(B) LIMITATION ON HIGH COST OUTLIER

9 PAYMENT AMOUNTS.—Notwithstanding sub10 paragraph (A), the Secretary shall set the fixed 

11 loss amount for high cost outlier payments such 

12 that the estimated aggregate amount of high 

13 cost outlier payments made for standard Fed14 eral payment rate discharges for fiscal years be15 ginning on or after October 1, 2017, shall be 

16 equal to 99.6875 percent of 8 percent of esti17 mated aggregate payments for standard Fed18 eral payment rate discharges for each such fis19 cal year. 

20 ‘‘(C) WAIVER OF BUDGET NEUTRALITY.— 

21 Any reduction in payments resulting from the 

22 application of subparagraph (B) shall not be 

23 taken into account in applying any budget neu24 trality provision under such system. 
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1 ‘‘(D) NO EFFECT ON SITE NEUTRAL HIGH

2 COST OUTLIER PAYMENT RATE.—This para3 graph shall not apply with respect to the com4 putation of the applicable site neutral payment 

5 rate under paragraph (6).’’. 

6 SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH 

7 NOT APPLYING DOCUMENTATION AND COD8 ING ADJUSTMENTS. 

9 Section 7(b)(1)(B)(iii) of the TMA, Abstinence Edu10 cation, and QI Programs Extension Act of 2007 (Public 

11 Law 110–90), as amended by section 631(b) of the Amer12 ican Taxpayer Relief Act of 2012 (Public Law 122–240) 

13 and section 414(1)(B)(iii) of the Medicare Access and 

14 CHIP Reauthorization Act of 2015 (Public Law 114–10), 

15 is amended by striking ‘‘an increase of 0.5 percentage 

16 points for discharges occurring during each of fiscal years 

17 2018 through 2023’’ and inserting ‘‘an increase of 0.4590 

18 percentage points for discharges occurring during fiscal 

19 year 2018 and 0.5 percentage points for discharges occur20 ring during each of fiscal years 2019 through 2023’’. 
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1 TITLE II—PROVISIONS RELAT2 ING TO MEDICARE PART B 

3 SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD 

4 PROSPECTIVE PAYMENT SYSTEM FOR SERV5 ICES FURNISHED BY MID-BUILD OFF-CAMPUS 

6 OUTPATIENT DEPARTMENTS OF PROVIDERS. 

7 (a) IN GENERAL.—Section 1833(t)(21) of the Social 

8 Security Act (42 U.S.C. 1395l(t)(21)) is amended— 

9 (1) in subparagraph (B)— 

10 (A) in clause (i), by striking ‘‘clause (ii)’’ 

11 and inserting ‘‘the subsequent provisions of this 

12 subparagraph’’; and 

13 (B) by adding at the end the following new 

14 clauses: 

15 ‘‘(iii) DEEMED TREATMENT FOR

16 2017.—For purposes of applying clause (ii) 

17 with respect to applicable items and serv18 ices furnished during 2017, a department 

19 of a provider (as so defined) not described 

20 in such clause is deemed to be billing 

21 under this subsection with respect to cov22 ered OPD services furnished prior to No23 vember 2, 2015, if the Secretary received 

24 from the provider prior to December 2, 

25 2015, an attestation (pursuant to section 
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1 413.65(b)(3) of title 42 of the Code of 

2 Federal Regulations) that such department 

3 was a department of a provider (as so de4 fined). 

5 ‘‘(iv) ALTERNATIVE EXCEPTION BE6 GINNING WITH 2018.—For purposes of 

7 paragraph (1)(B)(v) and this paragraph 

8 with respect to applicable items and serv9 ices furnished during 2018 or a subsequent 

10 year, the term ‘off-campus outpatient de11 partment of a provider’ also shall not in12 clude a department of a provider (as so de13 fined) that is not described in clause (ii) 

14 if— 

15 ‘‘(I) the Secretary receives from 

16 the provider an attestation (pursuant 

17 to such section 413.65(b)(3)) not later 

18 than December 31, 2016 (or, if later, 

19 60 days after the date of the enact20 ment of this clause), that such depart21 ment met the requirements of a de22 partment of a provider specified in 

23 section 413.65 of title 42 of the Code 

24 of Federal Regulations; 
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1 ‘‘(II) the provider includes such 

2 department as part of the provider on 

3 its enrollment form in accordance with 

4 the enrollment process under section 

5 1866(j); and 

6 ‘‘(III) the department met the 

7 mid-build requirement of clause (v) 

8 and the Secretary receives, not later 

9 than 60 days after the date of the en10 actment of this clause, from the chief 

11 executive officer or chief operating of12 ficer of the provider a written certifi13 cation that the department met such 

14 requirement. 

15 ‘‘(v) MID-BUILD REQUIREMENT DE16 SCRIBED.—The mid-build requirement of 

17 this clause is, with respect to a department 

18 of a provider, that before November 2, 

19 2015, the provider had a binding written 

20 agreement with an outside unrelated party 

21 for the actual construction of such depart22 ment. 

23 ‘‘(vii) AUDIT.—Not later than Decem24 ber 31, 2018, the Secretary shall audit the 

25 compliance with requirements of clause (iv) 
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1 with respect to each department of a pro2 vider to which such clause applies. If the 

3 Secretary finds as a result of an audit 

4 under this clause that the applicable re5 quirements were not met with respect to 

6 such department, the department shall not 

7 be excluded from the term ‘off-campus out8 patient department of a provider’ under 

9 such clause. 

10 ‘‘(viii) IMPLEMENTATION.—For pur11 poses of implementing clauses (iii) through 

12 (vii): 

13 ‘‘(I) Notwithstanding any other 

14 provision of law, the Secretary may 

15 implement such clauses by program 

16 instruction or otherwise. 

17 ‘‘(II) Subchapter I of chapter 35 

18 of title 44, United States Code, shall 

19 not apply. 

20 ‘‘(III) For purposes of carrying 

21 out this subparagraph with respect to 

22 clauses (iii) and (iv) (and clause (vii) 

23 insofar as it relates to clause (iv)), 

24 $10,000,000 shall be available from 

25 the Federal Supplementary Medical 
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1 Insurance Trust Fund under section 

2 1841, to remain available until De3 cember 31, 2018.’’; and 

4 (2) in subparagraph (E), by adding at the end 

5 the following new clause: 

6 ‘‘(iv) The determination of an audit 

7 under subparagraph (B)(vii).’’. 

8 (b) EFFECTIVE DATE.—The amendments made by 

9 this section shall be effective as if included in the enact10 ment of section 603 of the Bipartisan Budget Act of 2015 

11 (Public Law 114–74). 

12 SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAM13 PUS OUTPATIENT DEPARTMENT OF A PRO14 VIDER POLICY. 

15 (a) IN GENERAL.—Section 1833(t)(21)(B) of the So16 cial Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended 

17 by section 201(a), is amended— 

18 (1) by inserting after clause (v) the following 

19 new clause: 

20 ‘‘(vi) EXCLUSION FOR CERTAIN CAN21 CER HOSPITALS.—For purposes of para22 graph (1)(B)(v) and this paragraph with 

23 respect to applicable items and services 

24 furnished during 2017 or a subsequent 

25 year, the term ‘off-campus outpatient de-
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1 partment of a provider’ also shall not in2 clude a department of a provider (as so de3 fined) that is not described in clause (ii) if 

4 the provider is a hospital described in sec5 tion 1886(d)(1)(B)(v) and— 

6 ‘‘(I) in the case of a department 

7 that met the requirements of section 

8 413.65 of title 42 of the Code of Fed9 eral Regulations after November 1, 

10 2015, and before the date of the en11 actment of this clause, the Secretary 

12 receives from the provider an attesta13 tion that such department met such 

14 requirements not later than 60 days 

15 after such date of enactment; or 

16 ‘‘(II) in the case of a department 

17 that meets such requirements after 

18 such date of enactment, the Secretary 

19 receives from the provider an attesta20 tion that such department meets such 

21 requirements not later than 60 days 

22 after the date such requirements are 

23 first met with respect to such depart24 ment.’’; 
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1 (2) in clause (vii), by inserting after the first 

2 sentence the following: ‘‘Not later than 2 years after 

3 the date the Secretary receives an attestation under 

4 clause (vi) relating to compliance of a department of 

5 a provider with requirements referred to in such 

6 clause, the Secretary shall audit the compliance with 

7 such requirements with respect to the department.’’; 

8 and 

9 (3) in clause (viii)(III), by adding at the end 

10 the following: ‘‘For purposes of carrying out this 

11 subparagraph with respect to clause (vi) (and clause 

12 (vii) insofar as it relates to such clause), $2,000,000 

13 shall be available from the Federal Supplementary 

14 Medical Insurance Trust Fund under section 1841, 

15 to remain available until expended.’’. 

16 (b) OFFSETTING SAVINGS.—Section 1833(t)(18) of 

17 the Social Security Act (42 U.S.C. 1395l(t)(18)) is 

18 amended— 

19 (1) in subparagraph (B), by inserting ‘‘, subject 

20 to subparagraph (C),’’ after ‘‘shall’’; and 

21 (2) by adding at the end the following new sub22 paragraph: 

23 ‘‘(C) TARGET PCR ADJUSTMENT.—In ap24 plying section 419.43(i) of title 42 of the Code 

25 of Federal Regulations to implement the appro-
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1 priate adjustment under this paragraph for 

2 services furnished on or after January 1, 2018, 

3 the Secretary shall use a target PCR that is 1.0 

4 percentage points less than the target PCR that 

5 would otherwise apply. In addition to the per6 centage point reduction under the previous sen7 tence, the Secretary may consider making an 

8 additional percentage point reduction to such 

9 target PCR that takes into account payment 

10 rates for applicable items and services described 

11 in paragraph (21)(C) other than for services 

12 furnished by hospitals described in section 

13 1886(d)(1)(B)(v). In making any budget neu14 trality adjustments under this subsection for 

15 2018 or a subsequent year, the Secretary shall 

16 not take into account the reduced expenditures 

17 that result from the application of this subpara18 graph.’’. 

19 (c) EFFECTIVE DATE.—The amendments made by 

20 this section shall be effective as if included in the enact21 ment of section 603 of the Bipartisan Budget Act of 2015 

22 (Public Law 114–74). 
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1 SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN 

2 AMBULATORY SURGICAL CENTERS FOR 

3 MEANINGFUL USE AND MIPS. 

4 (a) IN GENERAL.—Section 1848(a)(7)(D) of the So5 cial Security Act (42 U.S.C. 1395w–4(a)(7)(D)) is amend6 ed— 

7 (1) by striking ‘‘HOSPITAL-BASED ELIGIBLE

8 PROFESSIONALS’’ and all that follows through ‘‘No 

9 payment’’ and inserting the following: ‘‘HOSPITAL10 BASED AND AMBULATORY SURGICAL CENTER-BASED

11 ELIGIBLE PROFESSIONALS.— 

12 ‘‘(i) HOSPITAL-BASED.—No pay13 ment’’; and 

14 (2) by adding at the end the following new 

15 clauses: 

16 ‘‘(ii) AMBULATORY SURGICAL CEN17 TER-BASED.—Subject to clause (iv), no 

18 payment adjustment may be made under 

19 subparagraph (A) for 2017 and 2018 in 

20 the case of an eligible professional with re21 spect to whom substantially all of the cov22 ered professional services furnished by 

23 such professional are furnished in an am24 bulatory surgical center. 

25 ‘‘(iii) DETERMINATION.—The deter26 mination of whether an eligible profes-
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1 sional is an eligible professional described 

2 in clause (ii) may be made on the basis 

3 of— 

4 ‘‘(I) the site of service (as de5 fined by the Secretary); or 

6 ‘‘(II) an attestation submitted by 

7 the eligible professional. 

8 Determinations made under subclauses (I) 

9 and (II) shall be made without regard to 

10 any employment or billing arrangement be11 tween the eligible professional and any 

12 other supplier or provider of services. 

13 ‘‘(iv) SUNSET.—Clause (ii) shall no 

14 longer apply as of the first year that be15 gins more than 3 years after the date on 

16 which the Secretary determines, through 

17 notice and comment rulemaking, that cer18 tified EHR technology applicable to the 

19 ambulatory surgical center setting is avail20 able.’’. 

21 (b) CONTINUED APPLICATION OF CERTAIN PROVI22 SIONS UNDER MIPS.—Section 1848(o)(2)(D) of the So23 cial Security Act (42 U.S.C. 1395w–4(o)(2)(D)) is amend24 ed by adding at the end the following new sentence: ‘‘The 

25 provisions of subparagraphs (B) and (D) of subsection 
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1 (a)(7), including the application of clause (iv) of such sub2 paragraph (D), shall apply to assessments of MIPS eligi3 ble professionals under subsection (q) with respect to the 

4 performance category described in subsection (q)(2)(A)(iv) 

5 in a manner similar to the manner in which such provi6 sions apply with respect to payment adjustments made 

7 under subsection (a)(7)(A).’’. 

8 TITLE III—OTHER MEDICARE 

9 PROVISIONS 

10 SEC. 301. DELAY IN AUTHORITY TO TERMINATE CON11 TRACTS FOR MEDICARE ADVANTAGE PLANS 

12 FAILING TO ACHIEVE MINIMUM QUALITY 

13 RATINGS. 

14 (a) FINDINGS.—Consistent with the studies provided 

15 under the IMPACT Act of 2014 (Public Law 113–185), 

16 it is the intent of Congress— 

17 (1) to continue to study and request input on 

18 the effects of socioeconomic status and dual-eligible 

19 populations on the Medicare Advantage STARS rat20 ing system before reforming such system with the 

21 input of stakeholders; and 

22 (2) pending the results of such studies and 

23 input, to provide for a temporary delay in authority 

24 of the Centers for Medicare & Medicaid Services 

25 (CMS) to terminate Medicare Advantage plan con-
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1 tracts solely on the basis of performance of plans 

2 under the STARS rating system. 

3 (b) DELAY IN MA CONTRACT TERMINATION AU4 THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM

5 QUALITY RATINGS.—Section 1857(h) of the Social Secu6 rity Act (42 U.S.C. 1395w–27(h)) is amended by adding 

7 at the end the following new paragraph: 

8 ‘‘(3) DELAY IN CONTRACT TERMINATION AU9 THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM

10 QUALITY RATING.—During the period beginning on 

11 the date of the enactment of this paragraph and 

12 through the end of plan year 2018, the Secretary 

13 may not terminate a contract under this section with 

14 respect to the offering of an MA plan by a Medicare 

15 Advantage organization solely because the MA plan 

16 has failed to achieve a minimum quality rating 

17 under the 5-star rating system under section 

18 1853(o)(4).’’. 

19 SEC. 302. REQUIREMENT FOR ENROLLMENT DATA REPORT20 ING FOR MEDICARE. 

21 Section 1874 of the Social Security Act (42 U.S.C. 

22 1395kk) is amended by adding at the end the following 

23 new subsection: 

24 ‘‘(g) REQUIREMENT FOR ENROLLMENT DATA RE25 PORTING.— 
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1 ‘‘(1) IN GENERAL.—Each year (beginning with 

2 2016), the Secretary shall submit to the Committees 

3 on Ways and Means and Energy and Commerce of 

4 the House of Representatives and the Committee on 

5 Finance of the Senate a report on Medicare enroll6 ment data (and, in the case of part A, on data on 

7 individuals receiving benefits under such part) as of 

8 a date in such year specified by the Secretary. Such 

9 data shall be presented— 

10 ‘‘(A) by Congressional district and State; 

11 and 

12 ‘‘(B) in a manner that provides for such 

13 data based on— 

14 ‘‘(i) fee-for-service enrollment (as de15 fined in paragraph (2)); 

16 ‘‘(ii) enrollment under part C (includ17 ing separate for aggregate enrollment in 

18 MA–PD plans and aggregate enrollment in 

19 MA plans that are not MA–PD plans); and 

20 ‘‘(iii) enrollment under part D. 

21 ‘‘(2) FEE-FOR-SERVICE ENROLLMENT DE22 FINED.—For purpose of paragraph (1)(B)(i), the 

23 term ‘fee-for-service enrollment’ means aggregate en24 rollment (including receipt of benefits other than 

25 through enrollment) under— 
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1 ‘‘(A) part A only; 

2 ‘‘(B) part B only; and 

3 ‘‘(C) both part A and part B.’’. 

4 SEC. 303. UPDATING THE WELCOME TO MEDICARE PACK5 AGE. 

6 (a) IN GENERAL.—Not later than 12 months after 

7 the last day of the period for the request of information 

8 described in subsection (b), the Secretary of Health and 

9 Human Services shall, taking into consideration informa10 tion collected pursuant to subsection (b), update the infor11 mation included in the Welcome to Medicare package to 

12 include information, presented in a clear and simple man13 ner, about options for receiving benefits under the Medi14 care program under title XVIII of the Social Security Act 

15 (42 U.S.C. 1395 et seq.), including through the original 

16 medicare fee-for-service program under parts A and B of 

17 such title (42 U.S.C. 1395c et seq., 42 U.S.C. 1395j et 

18 seq.), Medicare Advantage plans under part C of such title 

19 (42 U.S.C. 1395w–21 et seq.), and prescription drug plans 

20 under part D of such title (42 U.S.C. 1395w–101 et 

21 seq.)). The Secretary shall make subsequent updates to 

22 the information included in the Welcome to Medicare 

23 package as appropriate. 

24 (b) REQUEST FOR INFORMATION.—Not later than 6 

25 months after the date of the enactment of this Act, the 
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1 Secretary of Health and Human Services shall request in2 formation, including recommendations, from stakeholders 

3 (including patient advocates, issuers, and employers) on 

4 information included in the Welcome to Medicare package, 

5 including pertinent data and information regarding enroll6 ment 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 

poses. coding and enrollment data, and for other pursuppliers and increased transparency in hospital program for certain providers of services and provide for regulatory relief under the Medicare