I 

114TH CONGRESS 

2D SESSION H. R. 5273 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 18, 2016 

Mr. TIBERI (for himself and Mr. MCDERMOTT) 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 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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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


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

2 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 off-campus outpatient departments of providers under development. 

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. 

3 TITLE I—PROVISIONS RELATING 

4 TO MEDICARE PART A 

5 SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS 

6 VERSION OF MS–DRG CODES FOR SIMILAR 

7 HOSPITAL SERVICES. 

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

9 1395ww) is amended by adding at the end the following 

10 new subsection: 

11 ‘‘(t) RELATING SIMILAR INPATIENT AND OUT12 PATIENT HOSPITAL SERVICES.— 


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1 ‘‘(1) DEVELOPMENT OF HCPCS VERSION OF

2 MS–DRG CODES.— 

3 ‘‘(A) IN GENERAL.—Not later than Janu4 ary 1, 2018, the Secretary shall develop 

5 HCPCS versions for MS–DRGs that is similar 

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

7 that, to the extent possible, the MS–DRG as8 signment shall be similar for a claim coded with 

9 the HCPCS version as an identical claim coded 

10 with a ICD–10–PCS code. 

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

12 In carrying out subparagraph (A), the Sec13 retary shall develop HCPCS versions of MS– 

14 DRG codes for not fewer than 10 surgical MS– 

15 DRGs. 

16 ‘‘(C) PUBLICATION AND DISSEMINATION

17 OF THE HCPCS VERSIONS OF MS–DRGS.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 shall develop a HCPCS MS–DRG defini20 tions manual and software that is similar 

21 to the definitions manual and software for 

22 ICD–10–PCS codes for such MS–DRGs. 

23 The Secretary shall post the HCPCS MS– 

24 DRG definitions manual and software on 

25 the Internet website of the Centers for 


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1 Medicare & Medicaid Services. The 

2 HCPCS MS–DRG definitions manual and 

3 software shall be in the public domain and 

4 available for use and redistribution without 

5 charge. 

6 ‘‘(ii) USE OF PREVIOUS ANALYSIS

7 DONE BY MEDPAC.—In developing the 

8 HCPCS MS–DRG definitions manual and 

9 software under clause (i), the Secretary 

10 shall consult with the Medicare Payment 

11 Advisory Commission and shall consider 

12 the analysis done by such Commission in 

13 translating outpatient surgical claims into 

14 inpatient surgical MS–DRGs in preparing 

15 chapter 7 (relating to hospital short-stay 

16 policy issues) of its ‘Medicare and the 

17 Health Care Delivery System’ report sub18 mitted to Congress in June 2015. 

19 ‘‘(D) DEFINITION AND REFERENCE.—In 

20 this paragraph: 

21 ‘‘(i) HCPCS.—The term ‘HCPCS’ 

22 means, with respect to hospital items and 

23 services, the code under the Healthcare 

24 Common Procedure Coding System 


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

2 items and services. 

3 ‘‘(ii) ICD–10–PCS.—The term ‘ICD– 

4 10–PCS’ means the International Classi5 fication of Diseases, 10th Revision, Proce6 dure Coding System, and includes a subse7 quent revision of such International Classi8 fication of Diseases, Procedure Coding 

9 System.’’. 

10 SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE 

11 MEDICARE HOSPITAL READMISSION PRO12 GRAM. 

13 (a) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGI14 BLE POPULATION.—Section 1886(q)(3) of the Social Se15 curity Act (42 U.S.C. 1395ww(q)(3)) is amended— 

16 (1) in subparagraph (A), by inserting ‘‘subject 

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

18 (1),’’; and 

19 (2) by adding at the end the following new sub20 paragraph: 

21 ‘‘(D) TRANSITIONAL ADJUSTMENT FOR

22 DUAL ELIGIBLES.— 

23 ‘‘(i) IN GENERAL.—In determining a 

24 hospital’s adjustment factor under this 

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1 ments for discharges occurring during and 

2 after fiscal year 2019, and before the ap3 plication of clause (i) of subparagraph (E), 

4 the Secretary shall assign hospitals to 

5 groups (as defined by the Secretary under 

6 clause (ii)) and apply the applicable provi7 sions of this subsection using a method8 ology in a manner that allows for separate 

9 comparison of hospitals within each such 

10 group, as determined by the Secretary. 

11 ‘‘(ii) DEFINING GROUPS.—For pur12 poses of this subparagraph, the Secretary 

13 shall define groups of hospitals based on 

14 their overall proportion of inpatients who 

15 are full-benefit dual eligible individuals (as 

16 defined in section 1935(c)(6)). In defining 

17 groups, the Secretary shall consult the 

18 Medicare Payment Advisory Commission 

19 and may consider the analysis done by 

20 such Commission in preparing the portion 

21 of its report submitted to Congress in June 

22 2013 relating to readmissions. 

23 ‘‘(iii) MINIMIZING REPORTING BUR24 DEN ON HOSPITALS.—In carrying out this 

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1 pose any additional reporting requirements 

2 on hospitals. 

3 ‘‘(iv) BUDGET NEUTRAL DESIGN

4 METHODOLOGY.—The Secretary shall de5 sign the methodology to implement this 

6 subparagraph so that the estimated total 

7 amount of reductions in payments under 

8 this subsection equals the estimated total 

9 amount of reductions in payments that 

10 would otherwise occur under this sub11 section if this subparagraph did not 

12 apply.’’. 

13 (b) SUBSEQUENT ADJUSTMENTS BASED ON IM14 PACT REPORTS.—Section 1886(q)(3) of the Social Secu15 rity Act (42 U.S.C. 1395ww(q)(3)), as amended by sub16 section (a), is further amended by adding at the end the 

17 following new subparagraph: 

18 ‘‘(E) CHANGES IN RISK ADJUSTMENT.— 

19 ‘‘(i) CONSIDERATION OF REC20 OMMENDATIONS IN IMPACT REPORTS.— 

21 The Secretary may take into account the 

22 studies conducted and the recommenda23 tions made by the Secretary under section 

24 2(d)(1) of the IMPACT Act of 2014 (Pub25 lic Law 113–185; 42 U.S.C. 1395lll note) 


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1 with respect to the application under this 

2 subsection of risk adjustment methodolo3 gies. Nothing in this clause shall be con4 strued as precluding consideration of the 

5 use of groupings of hospitals.’’. 

6 (c) MEDPAC STUDY ON READMISSIONS PROGRAM.— 

7 The Medicare Payment Advisory Commission shall con8 duct a study to review overall hospital readmissions de9 scribed in section 1886(q)(5)(E) of the Social Security Act 

10 (42 U.S.C. 1395ww(q)(5)(E)) and whether such readmis11 sions are related to any changes in outpatient and emer12 gency services furnished. The Commission shall submit to 

13 Congress a report on such study in its report to Congress 

14 in June 2017. 

15 (d) ADDRESSING ISSUE OF CERTAIN PATIENTS.— 

16 Subparagraph (E) of section 1886(q)(3) of the Social Se17 curity Act (42 U.S.C. 1395ww(q)(3)), as added by sub18 section (b), is further amended by adding at the end the 

19 following new clause: 

20 ‘‘(ii) CONSIDERATION OF EXCLUSION

21 OF PATIENT CASES BASED ON V OR OTHER

22 APPROPRIATE CODES.—In promulgating 

23 regulations to carry out this subsection 

24 with respect to discharges occurring after 

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1 sider the use of V or other ICD-related 

2 codes for removal of a readmission. The 

3 Secretary may consider modifying meas4 ures under this subsection to incorporate V 

5 or other ICD-related codes at the same 

6 time as other changes are being made 

7 under this subparagraph.’’. 

8 (e) REMOVAL OF CERTAIN READMISSIONS.—Sub9 paragraph (E) of section 1886(q)(3) of the Social Security 

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

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

12 adding at the end the following new clause: 

13 ‘‘(iii) REMOVAL OF CERTAIN RE14 ADMISSIONS.—In promulgating regulations 

15 to carry out this subsection, with respect 

16 to discharges occurring after fiscal year 

17 2018, the Secretary may consider removal 

18 as a readmission of an admission that is 

19 classified within one or more of the fol20 lowing: transplants, end-stage renal dis21 ease, burns, trauma, psychosis, or sub22 stance abuse. The Secretary may consider 

23 modifying measures under this subsection 

24 to remove readmissions at the same time 


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1 as other changes are being made under 

2 this subparagraph.’’. 

3 SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMU4 NITY HOSPITAL DEMONSTRATION PROGRAM. 

5 (a) EXTENSION.—Section 410A of the Medicare Pre6 scription Drug, Improvement, and Modernization Act of 

7 2003 (Public Law 108–173; 42 U.S.C. 1395ww note), as 

8 amended by sections 3123 and 10313 of the Patient Pro9 tection and Affordable Care Act (Public Law 111–148), 

10 is amended— 

11 (1) in subsection (a)(5), by striking ‘‘5-year ex12 tension period’’ and inserting ‘‘10-year extension pe13 riod’’; and 

14 (2) in subsection (g)— 

15 (A) in the subsection heading, by striking 

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

17 (B) in paragraph (1), by striking ‘‘addi18 tional 5-year’’ and inserting ‘‘additional 10- 

19 year’’; 

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

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

22 place it appears; 

23 (D) in paragraph (4)(B)— 


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

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

3 ‘‘hospital during’’; and 

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

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

6 day of’’; and 

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

8 paragraphs: 

9 ‘‘(5) OTHER HOSPITALS IN DEMONSTRATION

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

11 year extension period, the Secretary shall apply the 

12 provisions of paragraph (4) to rural community hos13 pitals that are not described in paragraph (4) but 

14 are participating in the demonstration program 

15 under this section as of December 30, 2014, in a 

16 similar manner as such provisions apply to rural 

17 community hospitals described in paragraph (4). 

18 ‘‘(6) EXPANSION OF DEMONSTRATION PROGRAM

19 TO RURAL AREAS IN ANY STATE.— 

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

21 notwithstanding subsection (a)(2) or paragraph 

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

23 after the date of the enactment of this para24 graph, issue a solicitation for applications to se25 lect up to the maximum number of additional 


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1 rural community hospitals located in any State 

2 to participate in the demonstration program 

3 under this section for the second 5 years of the 

4 10-year extension period without exceeding the 

5 limitation under paragraph (3) of this sub6 section. 

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

8 rural community hospitals that submitted an 

9 application pursuant to the solicitation under 

10 subparagraph (A) to select for participation in 

11 the demonstration program, the Secretary— 

12 ‘‘(i) shall give priority to rural com13 munity hospitals located in one of the 20 

14 States with the lowest population densities 

15 (as determined by the Secretary using the 

16 2015 Statistical Abstract of the United 

17 States); and 

18 ‘‘(ii) may consider— 

19 ‘‘(I) closures of hospitals located 

20 in rural areas in the State in which 

21 the rural community hospital is lo22 cated during the 5-year period imme23 diately preceding the date of the en24 actment of this paragraph; and 


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1 ‘‘(II) the population density of 

2 the State in which the rural commu3 nity hospital is located.’’. 

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

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

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

7 the completion of the demonstration program under 

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

9 1, 2018’’; and 

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

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

12 SEC. 104. REGULATORY RELIEF FOR LTCHS. 

13 (a) TECHNICAL CHANGE TO THE MEDICARE LONG14 TERM CARE HOSPITAL MORATORIUM EXCEPTION.— 

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

16 Medicare, Medicaid, and SCHIP Extension Act of 

17 2007 (42 U.S.C. 1395ww note), as amended by sec18 tions 3106(b) and 10312(b) of Public Law 111–148, 

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

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

21 section 112 of the Protecting Access to Medicare Act 

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

23 under paragraph (1)(A)’’ and inserting ‘‘Any mora24 torium under paragraph (1)’’. 


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1 (2) EFFECTIVE DATE.—The amendment made 

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

3 the enactment of section 112 of the Protecting Ac4 cess to Medicare Act of 2014. 

5 (b) MODIFICATION TO MEDICARE LONG-TERM CARE

6 HOSPITAL HIGH COST OUTLIER PAYMENTS.—Section 

7 1886(m) of the Social Security Act (42 U.S.C. 

8 1395ww(m)) is amended by adding at the end the fol9 lowing new paragraph: 

10 ‘‘(7) TREATMENT OF HIGH COST OUTLIER PAY11 MENTS.— 

12 ‘‘(A) ADJUSTMENT TO THE STANDARD

13 FEDERAL PAYMENT RATE FOR ESTIMATED

14 HIGH COST OUTLIER PAYMENTS.—Under the 

15 system described in paragraph (1), for fiscal 

16 years beginning on or after October 1, 2017, 

17 the Secretary shall reduce the standard Federal 

18 payment rate as if the estimated aggregate 

19 amount of high cost outlier payments for stand20 ard Federal payment rate discharges for each 

21 such fiscal year would be equal to 8 percent of 

22 estimated aggregate payments for standard 

23 Federal payment rate discharges for each such 

24 fiscal year. 


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1 ‘‘(B) LIMITATION ON HIGH COST OUTLIER

2 PAYMENT AMOUNTS.—Notwithstanding sub3 paragraph (A), the Secretary shall set the fixed 

4 loss amount for high cost outlier payments such 

5 that the estimated aggregate amount of high 

6 cost outlier payments made for standard Fed7 eral payment rate discharges for fiscal years be8 ginning on or after October 1, 2017, shall be 

9 equal to 99.6875 percent of 8 percent of esti10 mated aggregate payments for standard Fed11 eral payment rate discharges for each such fis12 cal year. 

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

14 Any reduction in payments resulting from the 

15 application of subparagraph (B) shall not be 

16 taken into account in applying any budget neu17 trality provision under such system. 

18 ‘‘(D) NO EFFECT ON SITE NEUTRAL HIGH

19 COST OUTLIER PAYMENT RATE.—This para20 graph shall not apply with respect to the com21 putation of the applicable site neutral payment 

22 rate under paragraph (6).’’. 


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

2 NOT APPLYING DOCUMENTATION AND COD3 ING ADJUSTMENTS. 

4 Section 7(b)(1)(B)(iii) of the TMA, Abstinence Edu5 cation, and QI Programs Extension Act of 2007 (Public 

6 Law 110–90), as amended by section 631(b) of the Amer7 ican Taxpayer Relief Act of 2012 (Public Law 122–240) 

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

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

10 is amended by striking ‘‘0.5 percentage points’’ and insert11 ing ‘‘0.4590 percentage points’’. 

12 TITLE II—PROVISIONS RELAT13 ING TO MEDICARE PART B 

14 SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD 

15 PROSPECTIVE PAYMENT SYSTEM FOR SERV16 ICES FURNISHED BY OFF-CAMPUS OUT17 PATIENT DEPARTMENTS OF PROVIDERS 

18 UNDER DEVELOPMENT. 

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

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

21 (1) in subparagraph (B)— 

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

23 and inserting ‘‘the subsequent provisions of this 

24 subparagraph’’; and 

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

26 clauses: 


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1 ‘‘(iii) DEEMED TREATMENT FOR

2 2017.—For purposes of applying clause (ii) 

3 with respect to applicable items and serv4 ices furnished during 2017, a department 

5 of a provider (as so defined) not described 

6 in such clause is deemed to be billing 

7 under this subsection with respect to cov8 ered OPD services furnished prior to No9 vember 2, 2015, if the Secretary received 

10 from the provider prior to December 2, 

11 2015, an attestation (pursuant to section 

12 413.65(b)(3) of title 42 of the Code of 

13 Federal Regulations) that such department 

14 was a department of a provider (as so de15 fined). 

16 ‘‘(iv) ALTERNATIVE EXCEPTION BE17 GINNING WITH 2018.—For purposes of 

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

19 with respect to applicable items and serv20 ices furnished during 2018 or a subsequent 

21 year, the term ‘off-campus outpatient de22 partment of a provider’ also shall not in23 clude a department of a provider (as so de24 fined) that is not described in clause (ii) 

25 if— 


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1 ‘‘(I) the Secretary receives from 

2 the provider an attestation (pursuant 

3 to such section 413.65(b)(3)) before 

4 July 1, 2016, that such department 

5 met the requirements of a department 

6 of a provider specified in section 

7 413.65 of title 42 of the Code of Fed8 eral Regulations; 

9 ‘‘(II) the provider includes such 

10 department as part of the provider on 

11 its enrollment form in accordance with 

12 the enrollment process under section 

13 1866(j); and 

14 ‘‘(III) before July 1, 2016, the 

15 department met the mid-build require16 ment of clause (v) and the Secretary 

17 receives from the chief executive offi18 cer or chief operating officer of the 

19 provider a written certification that 

20 the department met such requirement. 

21 ‘‘(v) MID-BUILD REQUIREMENT DE22 SCRIBED.—The mid-build requirement of 

23 this clause is, with respect to a department 

24 of a provider, that before November 2, 

25 2015, the provider had a binding written 


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1 agreement with an outside unrelated party 

2 for the actual construction of such depart3 ment. 

4 ‘‘(vi) AUDIT.—Not later than Decem5 ber 31, 2018, the Secretary shall audit the 

6 compliance with requirements of clause (iv) 

7 with respect to a department of a provider 

8 for which an attestation is submitted under 

9 such clause. If the Secretary finds as a re10 sult of an audit under this clause that the 

11 applicable requirements were not met with 

12 respect to such department, the depart13 ment shall not be excluded from the term 

14 ‘off-campus outpatient department of a 

15 provider’ under the respective clause. 

16 ‘‘(vii) IMPLEMENTATION.—For pur17 poses of implementing clauses (iii) through 

18 (vii): 

19 ‘‘(I) Notwithstanding any other 

20 provision of law, the Secretary may 

21 implement such clauses by program 

22 instruction or otherwise. 

23 ‘‘(II) Subchapter I of chapter 35 

24 of title 44, United States Code, shall 

25 not apply. 


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1 ‘‘(III) For purposes of carrying 

2 out this subparagraph with respect to 

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

4 insofar as it relates to such clauses), 

5 the Secretary shall provide for the 

6 transfer from the Supplementary 

7 Medical Insurance Trust Fund under 

8 section 1841, of $10,000,000 to the 

9 Centers for Medicare & Medicaid 

10 Services Program Management Ac11 count to remain available until De12 cember 31, 2018.’’; and 

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

14 the following new clause: 

15 ‘‘(iv) The determination of an audit 

16 under subparagraph (B)(vii).’’. 

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

18 this section shall be effective as if included in the enact19 ment of section 603 of the Bipartisan Budget Act of 2015 

20 (Public Law 114–74). 


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1 SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAM2 PUS OUTPATIENT DEPARTMENT OF A PRO3 VIDER POLICY. 

4 (a) IN GENERAL.—Section 1833(t)(21)(B) of the So5 cial Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended 

6 by section 201(a), is amended— 

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

8 new clause: 

9 ‘‘(vi) EXCLUSION FOR CERTAIN CAN10 CER HOSPITALS.—For purposes of para11 graph (1)(B)(v) and this paragraph with 

12 respect to applicable items and services 

13 furnished during 2017 or a subsequent 

14 year, the term ‘off-campus outpatient de15 partment of a provider’ also shall not in16 clude a department of a provider (as so de17 fined) that is not described in clause (ii) if 

18 the provider is a hospital described in sec19 tion 1886(d)(1)(B)(v) and— 

20 ‘‘(I) in the case of a department 

21 that met the requirements of section 

22 413.65 of title 42 of the Code of Fed23 eral Regulations after November 1, 

24 2015, and before the date of the en25 actment of this clause, the Secretary 

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1 tion that such department met such 

2 requirements not later than 60 days 

3 after such date of enactment; or 

4 ‘‘(II) in the case of a department 

5 that meets such requirements after 

6 such date of enactment, the Secretary 

7 receives from the provider an attesta8 tion that such department meets such 

9 requirements not later than 60 days 

10 after the date such requirements are 

11 first met with respect to such depart12 ment.’’; 

13 (2) in clause (vii), by inserting after the first 

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

15 the date the Secretary receives an attestation under 

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

17 a provider with requirements referred to in such 

18 clause, the Secretary shall audit the compliance with 

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

20 and 

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

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

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

24 (vii) insofar as it relates to such clause), the Sec25 retary shall provide for the transfer from the SupVerDate Sep 11 2014 18:41 May 20, 2016 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H5273.IH H5273

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1 plementary Medical Insurance Trust Fund under 

2 section 1841, of $2,000,000 to the Centers for Medi3 care & Medicaid Services Program Management Ac4 count to remain available until expended.’’ 

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

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

7 amended— 

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

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

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(C) TARGET PCR ADJUSTMENT.—In ap13 plying section 419.43(i) of title 42 of the Code 

14 of Federal Regulations to implement the appro15 priate adjustment under this paragraph for 

16 services furnished on or after January 1, 2018, 

17 the Secretary shall use a target PCR that is 1.0 

18 percentage points less than the target PCR that 

19 would otherwise apply. In addition to the per20 centage point reduction under the previous sen21 tence, the Secretary may consider making an 

22 additional percentage point reduction to such 

23 target PCR that takes into account payment 

24 rates for applicable items and services described 

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


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1 furnished by hospitals described in section 

2 1886(d)(1)(B)(v). In making any budget neu3 trality adjustments under this subsection for 

4 2018 or a subsequent year, the Secretary shall 

5 not take into account the reduced expenditures 

6 that result from the application of this subpara7 graph.’’. 

8 (c) 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. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN 

13 AMBULATORY SURGICAL CENTERS FOR 

14 MEANINGFUL USE AND MIPS. 

15 (a) IN GENERAL.—Section 1848(a)(7)(D) of the So16 cial Security Act (42 U.S.C. 1395w–4(a)(7)(D)) is amend17 ed— 

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

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

20 payment’’ and inserting the following: ‘‘HOSPITAL21 BASED AND AMBULATORY SURGICAL CENTER-BASED

22 ELIGIBLE PROFESSIONALS.— 

23 ‘‘(i) HOSPITAL-BASED.—No pay24 ment’’; and 


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

2 clauses: 

3 ‘‘(ii) AMBULATORY SURGICAL CEN4 TER-BASED.—Subject to clause (iv), no 

5 payment adjustment may be made under 

6 subparagraph (A) for 2017 and 2018 in 

7 the case of an eligible professional with re8 spect to whom substantially all of the cov9 ered professional services furnished by 

10 such professional are furnished in an am11 bulatory surgical center. 

12 ‘‘(iii) DETERMINATION.—The deter13 mination of whether an eligible profes14 sional is an eligible professional described 

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

16 of— 

17 ‘‘(I) the site of service (as de18 fined by the Secretary); or 

19 ‘‘(II) an attestation submitted by 

20 the eligible professional. 

21 Determinations made under subclauses (I) 

22 and (II) shall be made without regard to 

23 any employment or billing arrangement be24 tween the eligible professional and any 

25 other supplier or provider of services. 


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

2 longer apply as of the first year that be3 gins more than 3 years after the date on 

4 which the Secretary determines, through 

5 notice and comment rulemaking, that cer6 tified EHR technology applicable to the 

7 ambulatory surgical center setting is avail8 able.’’. 

9 (b) CONTINUED APPLICATION OF CERTAIN PROVI10 SIONS UNDER MIPS.—Section 1848(o)(2)(D) of the So11 cial Security Act (42 U.S.C. 1395w–4(o)(2)(D)) is amend12 ed by adding at the end the following new sentence: ‘‘The 

13 provisions of subparagraphs (B) and (D) of subsection 

14 (a)(7), including the application of clause (iv) of such sub15 paragraph (D), shall apply to assessments of MIPS eligi16 ble professionals under subsection (q) with respect to the 

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

18 in a manner similar to the manner in which such provi19 sions apply with respect to payment adjustments made 

20 under subsection (a)(7)(A).’’. 


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1 TITLE III—OTHER MEDICARE 

2 PROVISIONS 

3 SEC. 301. DELAY IN AUTHORITY TO TERMINATE CON4 TRACTS FOR MEDICARE ADVANTAGE PLANS 

5 FAILING TO ACHIEVE MINIMUM QUALITY 

6 RATINGS. 

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

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

9 it is the intent of Congress— 

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

11 the effects of socioeconomic status and dual-eligible 

12 populations on the Medicare Advantage STARS rat13 ing system before reforming such system with the 

14 input of stakeholders; and 

15 (2) pending the results of such studies and 

16 input, to provide for a temporary delay in authority 

17 of the Centers for Medicare & Medicaid Services 

18 (CMS) to terminate Medicare Advantage plan con19 tracts solely on the basis of performance of plans 

20 under the STARS rating system. 

21 (b) DELAY IN MA CONTRACT TERMINATION AU22 THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM

23 QUALITY RATINGS.—Section 1857(h) of the Social Secu24 rity Act (42 U.S.C. 1395w–27(h)) is amended by adding 

25 at the end the following new paragraph: 


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1 ‘‘(3) DELAY IN CONTRACT TERMINATION AU2 THORITY FOR PLANS FAILING TO ACHIEVE MINIMUM

3 QUALITY RATING.—During the period beginning on 

4 the date of enactment of this paragraph and through 

5 the end of plan year 2018, the Secretary may not 

6 terminate a contract under this section with respect 

7 to the offering of an MA plan by a Medicare Advan8 tage organization solely because the MA plan has 

9 failed to achieve a minimum quality rating under the 

10 5-star rating system under section 1853(o)(4).’’. 

11 SEC. 302. REQUIREMENT FOR ENROLLMENT DATA REPORT12 ING FOR MEDICARE. 

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

14 1395kk) is amended by adding at the end the following 

15 new subsection: 

16 ‘‘(g) REQUIREMENT FOR ENROLLMENT DATA RE17 PORTING.— 

18 ‘‘(1) IN GENERAL.—Each year (beginning with 

19 2016), the Secretary shall submit to the Committees 

20 on Ways and Means and Energy and Commerce of 

21 the House of Representatives and the Committee on 

22 Finance of the Senate a report on Medicare enroll23 ment data (and, in the case of part A, on data on 

24 individuals receiving benefits under such part) as of 


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

2 data shall be presented— 

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

4 and 

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

6 data based on— 

7 ‘‘(i) fee-for-service enrollment (as de8 fined in paragraph (2)); 

9 ‘‘(ii) enrollment under part C (includ10 ing separate for aggregate enrollment in 

11 MA–PD plans and aggregate enrollment in 

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

13 ‘‘(iii) enrollment under part D. 

14 ‘‘(2) FEE-FOR-SERVICE ENROLLMENT DE15 FINED.—For purpose of paragraph (1)(B)(i), the 

16 term ‘fee-for-service enrollment’ means aggregate en17 rollment (including receipt of benefits other than 

18 through enrollment) under— 

19 ‘‘(A) part A only; 

20 ‘‘(B) part B only; and 

21 ‘‘(C) both part A and part B.’’. 

22 SEC. 303. UPDATING THE WELCOME TO MEDICARE PACK23 AGE. 

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

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


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

2 Human Services shall, taking into consideration informa3 tion collected pursuant to subsection (b), update the infor4 mation included in the Welcome to Medicare package to 

5 include information, presented in a clear and simple man6 ner, about options for receiving benefits under the Medi7 care program under title XVIII of the Social Security Act 

8 (42 U.S.C. 1395 et seq.), including through the original 

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

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

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

12 (42 U.S.C. 1395w–21 et seq.), and prescription drug plans 

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

14 The Secretary shall make subsequent updates to the infor15 mation included in the Welcome to Medicare package as 

16 appropriate. 

17 (b) REQUEST FOR INFORMATION.—Not later than six 

18 months after the date of the enactment of this Act, the 

19 Secretary of Health and Human Services shall request in20 formation, including recommendations, from stakeholders 

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

22 information included in the Welcome to Medicare package, 

23 including pertinent data and information regarding enroll24 ment and coverage for Medicare eligible individuals. 

Æ 


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