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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4994 Enrolled Bill (ENR)]

        H.R.4994

                     One Hundred Thirteenth Congress

                                 of the

                        United States of America

                          AT THE SECOND SESSION

           Begun and held at the City of Washington on Friday,
           the third day of January, two thousand and fourteen

                                 An Act

 
     To amend title XVIII of the Social Security Act to provide for 
 standardized post-acute care assessment data for quality, payment, and 
               discharge planning, 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.
    This Act may be cited as the ``Improving Medicare Post-Acute Care 
Transformation Act of 2014'' or the ``IMPACT Act of 2014''.
SEC. 2. STANDARDIZATION OF POST-ACUTE CARE DATA.
    (a) In General.--Title XVIII of the Social Security Act is amended 
by adding at the end the following new section:
``SEC. 1899B. STANDARDIZED POST-ACUTE CARE (PAC) ASSESSMENT DATA FOR 
QUALITY, PAYMENT, AND DISCHARGE PLANNING.
    ``(a) Requirement for Standardized Assessment Data.--
        ``(1) In general.--The Secretary shall--
            ``(A) require under the applicable reporting provisions 
        post-acute care providers (as defined in paragraph (2)(A)) to 
        report--
                ``(i) standardized patient assessment data in 
            accordance with subsection (b);
                ``(ii) data on quality measures under subsection 
            (c)(1); and
                ``(iii) data on resource use and other measures under 
            subsection (d)(1);
            ``(B) require data described in subparagraph (A) to be 
        standardized and interoperable so as to allow for the exchange 
        of such data among such post-acute care providers and other 
        providers and the use by such providers of such data that has 
        been so exchanged, including by using common standards and 
        definitions, in order to provide access to longitudinal 
        information for such providers to facilitate coordinated care 
        and improved Medicare beneficiary outcomes; and
            ``(C) in accordance with subsections (b)(1) and (c)(2), 
        modify PAC assessment instruments (as defined in paragraph 
        (2)(B)) applicable to post-acute care providers to--
                ``(i) provide for the submission of standardized 
            patient assessment data under this title with respect to 
            such providers; and
                ``(ii) enable comparison of such assessment data across 
            all such providers to whom such data are applicable.
        ``(2) Definitions.--For purposes of this section:
            ``(A) Post-acute care (pac) provider.--The terms `post-
        acute care provider' and `PAC provider' mean--
                ``(i) a home health agency;
                ``(ii) a skilled nursing facility;
                ``(iii) an inpatient rehabilitation facility; and
                ``(iv) a long-term care hospital (other than a hospital 
            classified under section 1886(d)(1)(B)(iv)(II)).
            ``(B) PAC assessment instrument.--The term `PAC assessment 
        instrument' means--
                ``(i) in the case of home health agencies, the 
            instrument used for purposes of reporting and assessment 
            with respect to the Outcome and Assessment Information Set 
            (OASIS), as described in sections 484.55 and 484.250 of 
            title 42, the Code of Federal Regulations, or any successor 
            regulation, or any other instrument used with respect to 
            home health agencies for such purposes;
                ``(ii) in the case of skilled nursing facilities, the 
            resident's assessment under section 1819(b)(3);
                ``(iii) in the case of inpatient rehabilitation 
            facilities, any Medicare beneficiary assessment instrument 
            established by the Secretary for purposes of section 
            1886(j); and
                ``(iv) in the case of long-term care hospitals, the 
            Medicare beneficiary assessment instrument used with 
            respect to such hospitals for the collection of data 
            elements necessary to calculate quality measures as 
            described in the August 18, 2011, Federal Register (76 Fed. 
            Reg. 51754-51755), including for purposes of section 
            1886(m)(5)(C), or any other instrument used with respect to 
            such hospitals for assessment purposes.
            ``(C) Applicable reporting provision.--The term `applicable 
        reporting provision' means--
                ``(i) for home health agencies, section 
            1895(b)(3)(B)(v);
                ``(ii) for skilled nursing facilities, section 
            1888(e)(6);
                ``(iii) for inpatient rehabilitation facilities, 
            section 1886(j)(7); and
                ``(iv) for long-term care hospitals, section 
            1886(m)(5).
            ``(D) PAC payment system.--The term `PAC payment system' 
        means--
                ``(i) with respect to a home health agency, the 
            prospective payment system under section 1895;
                ``(ii) with respect to a skilled nursing facility, the 
            prospective payment system under section 1888(e);
                ``(iii) with respect to an inpatient rehabilitation 
            facility, the prospective payment system under section 
            1886(j); and
                ``(iv) with respect to a long-term care hospital, the 
            prospective payment system under section 1886(m).
            ``(E) Specified application date.--The term `specified 
        application date' means the following:
                ``(i) Quality measures.--In the case of quality 
            measures under subsection (c)(1)--

                    ``(I) with respect to the domain described in 
                subsection (c)(1)(A) (relating to functional status, 
                cognitive function, and changes in function and 
                cognitive function)--

                        ``(aa) for PAC providers described in clauses 
                    (ii) and (iii) of paragraph (2)(A), October 1, 
                    2016;
                        ``(bb) for PAC providers described in clause 
                    (iv) of such paragraph, October 1, 2018; and
                        ``(cc) for PAC providers described in clause 
                    (i) of such paragraph, January 1, 2019;

                    ``(II) with respect to the domain described in 
                subsection (c)(1)(B) (relating to skin integrity and 
                changes in skin integrity)--

                        ``(aa) for PAC providers described in clauses 
                    (ii), (iii), and (iv) of paragraph (2)(A), October 
                    1, 2016; and
                        ``(bb) for PAC providers described in clause 
                    (i) of such paragraph, January 1, 2017;

                    ``(III) with respect to the domain described in 
                subsection (c)(1)(C) (relating to medication 
                reconciliation)--

                        ``(aa) for PAC providers described in clause 
                    (i) of such paragraph, January 1, 2017; and
                        ``(bb) for PAC providers described in clauses 
                    (ii), (iii), and (iv) of such paragraph, October 1, 
                    2018;

                    ``(IV) with respect to the domain described in 
                subsection (c)(1)(D) (relating to incidence of major 
                falls)--

                        ``(aa) for PAC providers described in clauses 
                    (ii), (iii), and (iv) of paragraph (2)(A), October 
                    1, 2016; and
                        ``(bb) for PAC providers described in clause 
                    (i) of such paragraph, January 1, 2019; and

                    ``(V) with respect to the domain described in 
                subsection (c)(1)(E) (relating to accurately 
                communicating the existence of and providing for the 
                transfer of health information and care preferences)--

                        ``(aa) for PAC providers described in clauses 
                    (ii), (iii), and (iv) of paragraph (2)(A), October 
                    1, 2018; and
                        ``(bb) for PAC providers described in clause 
                    (i) of such paragraph, January 1, 2019.
                ``(ii) Resource use and other measures.--In the case of 
            resource use and other measures under subsection (d)(1)--

                    ``(I) for PAC providers described in clauses (ii), 
                (iii), and (iv) of paragraph (2)(A), October 1, 2016; 
                and
                    ``(II) for PAC providers described in clause (i) of 
                such paragraph, January 1, 2017.

            ``(F) Medicare beneficiary.--The term `Medicare 
        beneficiary' means an individual entitled to benefits under 
        part A or, as appropriate, enrolled for benefits under part B.
    ``(b) Standardized Patient Assessment Data.--
        ``(1) Requirement for reporting assessment data.--
            ``(A) In general.--Beginning not later than October 1, 
        2018, for PAC providers described in clauses (ii), (iii), and 
        (iv) of subsection (a)(2)(A) and January 1, 2019, for PAC 
        providers described in clause (i) of such subsection, the 
        Secretary shall require PAC providers to submit to the 
        Secretary, under the applicable reporting provisions and 
        through the use of PAC assessment instruments, the standardized 
        patient assessment data described in subparagraph (B). The 
        Secretary shall require such data be submitted with respect to 
        admission and discharge of an individual (and may be submitted 
        more frequently as the Secretary deems appropriate).
            ``(B) Standardized patient assessment data described.--For 
        purposes of subparagraph (A), the standardized patient 
        assessment data described in this subparagraph is data required 
        for at least the quality measures described in subsection 
        (c)(1) and that is with respect to the following categories:
                ``(i) Functional status, such as mobility and self care 
            at admission to a PAC provider and before discharge from a 
            PAC provider.
                ``(ii) Cognitive function, such as ability to express 
            ideas and to understand, and mental status, such as 
            depression and dementia.
                ``(iii) Special services, treatments, and 
            interventions, such as need for ventilator use, dialysis, 
            chemotherapy, central line placement, and total parenteral 
            nutrition.
                ``(iv) Medical conditions and co-morbidities, such as 
            diabetes, congestive heart failure, and pressure ulcers.
                ``(v) Impairments, such as incontinence and an impaired 
            ability to hear, see, or swallow.
                ``(vi) Other categories deemed necessary and 
            appropriate by the Secretary.
        ``(2) Alignment of claims data with standardized patient 
    assessment data.--To the extent practicable, not later than October 
    1, 2018, for PAC providers described in clauses (ii), (iii), and 
    (iv) of subsection (a)(2)(A), and January 1, 2019, for PAC 
    providers described in clause (i) of such subsection, the Secretary 
    shall match claims data with assessment data pursuant to this 
    section for purposes of assessing prior service use and concurrent 
    service use, such as antecedent hospital or PAC provider use, and 
    may use such matched data for such other uses as the Secretary 
    determines appropriate.
        ``(3) Replacement of certain existing data.--In the case of 
    patient assessment data being used with respect to a PAC assessment 
    instrument that duplicates or overlaps with standardized patient 
    assessment data within a category described in paragraph (1), the 
    Secretary shall, as soon as practicable, revise or replace such 
    existing data with the standardized data.
        ``(4) Clarification.--Standardized patient assessment data 
    submitted pursuant to this subsection shall not be used to require 
    individuals to be provided post-acute care by a specific type of 
    PAC provider in order for such care to be eligible for payment 
    under this title.
    ``(c) Quality Measures.--
        ``(1) Requirement for reporting quality measures.--Not later 
    than the specified application date, as applicable to measures and 
    PAC providers, the Secretary shall specify quality measures on 
    which PAC providers are required under the applicable reporting 
    provisions to submit standardized patient assessment data described 
    in subsection (b)(1) and other necessary data specified by the 
    Secretary. Such measures shall be with respect to at least the 
    following domains:
            ``(A) Functional status, cognitive function, and changes in 
        function and cognitive function.
            ``(B) Skin integrity and changes in skin integrity.
            ``(C) Medication reconciliation.
            ``(D) Incidence of major falls.
            ``(E) Accurately communicating the existence of and 
        providing for the transfer of health information and care 
        preferences of an individual to the individual, family 
        caregiver of the individual, and providers of services 
        furnishing items and services to the individual, when the 
        individual transitions--
                ``(i) from a hospital or critical access hospital to 
            another applicable setting, including a PAC provider or the 
            home of the individual; or
                ``(ii) from a PAC provider to another applicable 
            setting, including a different PAC provider, a hospital, a 
            critical access hospital, or the home of the individual.
        ``(2) Reporting through pac assessment instruments.--
            ``(A) In general.--To the extent possible, the Secretary 
        shall require such reporting by a PAC provider of quality 
        measures under paragraph (1) through the use of a PAC 
        assessment instrument and shall modify such PAC assessment 
        instrument as necessary to enable the use of such instrument 
        with respect to such quality measures.
            ``(B) Limitation.--The Secretary may not make significant 
        modifications to a PAC assessment instrument more than once per 
        calendar year or fiscal year, as applicable, unless the 
        Secretary publishes in the Federal Register a justification for 
        such significant modification.
        ``(3) Adjustments.--
            ``(A) In general.--The Secretary shall consider applying 
        adjustments to the quality measures under this subsection 
        taking into consideration the studies under section 2(d) of the 
        IMPACT Act of 2014.
            ``(B) Risk adjustment.--Such quality measures shall be risk 
        adjusted, as determined appropriate by the Secretary.
    ``(d) Resource Use and Other Measures.--
        ``(1) Requirement for resource use and other measures.--Not 
    later than the specified application date, as applicable to 
    measures and PAC providers, the Secretary shall specify resource 
    use and other measures on which PAC providers are required under 
    the applicable reporting provisions to submit any necessary data 
    specified by the Secretary, which may include standardized 
    assessment data in addition to claims data. Such measures shall be 
    with respect to at least the following domains:
            ``(A) Resource use measures, including total estimated 
        Medicare spending per beneficiary.
            ``(B) Discharge to community.
            ``(C) Measures to reflect all-condition risk-adjusted 
        potentially preventable hospital readmission rates.
        ``(2) Aligning methodology adjustments for resource use 
    measures.--
            ``(A) Period of time.--With respect to the period of time 
        used for calculating measures under paragraph (1)(A), the 
        Secretary shall, to the extent the Secretary determines 
        appropriate, align resource use with the methodology used for 
        purposes of section 1886(o)(2)(B)(ii).
            ``(B) Geographic and other adjustments.--The Secretary 
        shall standardize measures with respect to the domain described 
        in paragraph (1)(A) for geographic payment rate differences and 
        payment differentials (and other adjustments, as applicable) 
        consistent with the methodology published in the Federal 
        Register on August 18, 2011 (76 Fed. Reg. 51624 through 51626), 
        or any subsequent modifications made to the methodology.
            ``(C) Medicare spending per beneficiary.--The Secretary 
        shall adjust, as appropriate, measures with respect to the 
        domain described in paragraph (1)(A) for the factors applied 
        under section 1886(o)(2)(B)(ii).
        ``(3) Adjustments.--
            ``(A) In general.--The Secretary shall consider applying 
        adjustments to the resource use and other measures specified 
        under this subsection with respect to the domain described in 
        paragraph (1)(A), taking into consideration the studies under 
        section 2(d) of the IMPACT Act of 2014.
            ``(B) Risk adjustment.--Such resource use and other 
        measures shall be risk adjusted, as determined appropriate by 
        the Secretary.
    ``(e) Measurement Implementation Phases; Selection of Quality 
Measures and Resource Use and Other Measures.--
        ``(1) Measurement implementation phases.--In the case of 
    quality measures specified under subsection (c)(1) and resource use 
    and other measures specified under subsection (d)(1), the 
    provisions of this section shall be implemented in accordance with 
    the following phases:
            ``(A) Initial implementation phase.--The initial 
        implementation phase, with respect to such a measure, shall, in 
        accordance with subsections (c) and (d), as applicable, consist 
        of--
                ``(i) measure specification, including informing the 
            public of the measure's numerator, denominator, exclusions, 
            and any other aspects the Secretary determines necessary;
                ``(ii) data collection, including, in the case of 
            quality measures, requiring PAC providers to report data 
            elements needed to calculate such a measure; and
                ``(iii) data analysis, including, in the case of 
            resource use and other measures, the use of claims data to 
            calculate such a measure.
            ``(B) Second implementation phase.--The second 
        implementation phase, with respect to such a measure, shall 
        consist of the provision of feedback reports to PAC providers, 
        in accordance with subsection (f).
            ``(C) Third implementation phase.--The third implementation 
        phase, with respect to such a measure, shall consist of public 
        reporting of PAC providers' performance on such measure in 
        accordance with subsection (g).
        ``(2) Consensus-based entity.--
            ``(A) In general.--Subject to subparagraph (B), each 
        measure specified by the Secretary under this section shall be 
        endorsed by the entity with a contract under section 1890(a).
            ``(B) Exception.--In the case of a specified area or 
        medical topic determined appropriate by the Secretary for which 
        a feasible and practical measure has not been endorsed by the 
        entity with a contract under section 1890(a), the Secretary may 
        specify a measure that is not so endorsed as long as due 
        consideration is given to measures that have been endorsed or 
        adopted by a consensus organization identified by the 
        Secretary.
        ``(3) Treatment of application of pre-rulemaking process 
    (measure applications partnership process).--
            ``(A) In general.--Subject to subparagraph (B), the 
        provisions of section 1890A shall apply in the case of a 
        quality measure specified under subsection (c) or a resource 
        use or other measure specified under subsection (d).
            ``(B) Exceptions.--
                ``(i) Expedited procedures.--For purposes of satisfying 
            subparagraph (A), the Secretary may use expedited 
            procedures, such as ad-hoc reviews, as necessary, in the 
            case of a quality measure specified under subsection (c) or 
            a resource use or other measure specified in subsection (d) 
            required with respect to data submissions under the 
            applicable reporting provisions during the 1-year period 
            before the specified application date applicable to such a 
            measure and provider involved.
                ``(ii) Option to waive provisions.--The Secretary may 
            waive the application of the provisions of section 1890A in 
            the case of a quality measure or resource use or other 
            measure described in clause (i), if the application of such 
            provisions (including through the use of an expedited 
            procedure described in such clause) would result in the 
            inability of the Secretary to satisfy any deadline 
            specified in this section with respect to such measure.
    ``(f) Feedback Reports to PAC Providers.--
        ``(1) In general.--Beginning one year after the specified 
    application date, as applicable to PAC providers and quality 
    measures and resource use and other measures under this section, 
    the Secretary shall provide confidential feedback reports to such 
    PAC providers on the performance of such providers with respect to 
    such measures required under the applicable provisions.
        ``(2) Frequency.--To the extent feasible, the Secretary shall 
    provide feedback reports described in paragraph (1) not less 
    frequently than on a quarterly basis. Notwithstanding the previous 
    sentence, with respect to measures described in such paragraph that 
    are reported on an annual basis, the Secretary may provide such 
    feedback reports on an annual basis.
    ``(g) Public Reporting of PAC Provider Performance.--
        ``(1) In general.--Subject to the succeeding paragraphs of this 
    subsection, the Secretary shall provide for public reporting of PAC 
    provider performance on quality measures under subsection (c)(1) 
    and the resource use and other measures under subsection (d)(1), 
    including by establishing procedures for making available to the 
    public information regarding the performance of individual PAC 
    providers with respect to such measures.
        ``(2) Opportunity to review.--The procedures under paragraph 
    (1) shall ensure, including through a process consistent with the 
    process applied under section 1886(b)(3)(B)(viii)(VII) for similar 
    purposes, that a PAC provider has the opportunity to review and 
    submit corrections to the data and information that is to be made 
    public with respect to the provider prior to such data being made 
    public.
        ``(3) Timing.--Such procedures shall provide that the data and 
    information described in paragraph (1), with respect to a measure 
    and PAC provider, is made publicly available beginning not later 
    than two years after the specified application date applicable to 
    such a measure and provider.
        ``(4) Coordination with existing programs.--Such procedures 
    shall provide that data and information described in paragraph (1) 
    with respect to quality measures and resource use and other 
    measures under subsections (c)(1) and (d)(1) shall be made publicly 
    available consistent with the following provisions:
            ``(A) In the case of home health agencies, section 
        1895(b)(3)(B)(v)(III).
            ``(B) In the case of skilled nursing facilities, sections 
        1819(i) and 1919(i).
            ``(C) In the case of inpatient rehabilitation facilities, 
        section 1886(j)(7)(E).
            ``(D) In the case of long-term care hospitals, section 
        1886(m)(5)(E).
    ``(h) Removing, Suspending, or Adding Measures.--
        ``(1) In general.--The Secretary may remove, suspend, or add a 
    quality measure or resource use or other measure described in 
    subsection (c)(1) or (d)(1), so long as, subject to paragraph (2), 
    the Secretary publishes in the Federal Register (with a notice and 
    comment period) a justification for such removal, suspension, or 
    addition.
        ``(2) Exception.--In the case of such a quality measure or 
    resource use or other measure for which there is a reason to 
    believe that the continued collection of such measure raises 
    potential safety concerns or would cause other unintended 
    consequences, the Secretary may promptly suspend or remove such 
    measure and satisfy paragraph (1) by publishing in the Federal 
    Register a justification for such suspension or removal in the next 
    rulemaking cycle following such suspension or removal.
    ``(i) Use of Standardized Assessment Data, Quality Measures, and 
Resource Use and Other Measures To Inform Discharge Planning and 
Incorporate Patient Preference.--
        ``(1) In general.--Not later than January 1, 2016, and 
    periodically thereafter (but not less frequently than once every 5 
    years), the Secretary shall promulgate regulations to modify 
    conditions of participation and subsequent interpretive guidance 
    applicable to PAC providers, hospitals, and critical access 
    hospitals. Such regulations and interpretive guidance shall require 
    such providers to take into account quality, resource use, and 
    other measures under the applicable reporting provisions (which, as 
    available, shall include measures specified under subsections (c) 
    and (d), and other relevant measures) in the discharge planning 
    process. Specifically, such regulations and interpretive guidance 
    shall address the settings to which a patient may be discharged in 
    order to assist subsection (d) hospitals, critical access 
    hospitals, hospitals described in section 1886(d)(1)(B)(v), PAC 
    providers, patients, and families of such patients with discharge 
    planning from inpatient settings, including such hospitals, and 
    from PAC provider settings. In addition, such regulations and 
    interpretive guidance shall include procedures to address--
            ``(A) treatment preferences of patients; and
            ``(B) goals of care of patients.
        ``(2) Discharge planning.--All requirements applied pursuant to 
    paragraph (1) shall be used to help inform and mandate the 
    discharge planning process.
        ``(3) Clarification.--Such regulations shall not require an 
    individual to be provided post-acute care by a specific type of PAC 
    provider in order for such care to be eligible for payment under 
    this title.
    ``(j) Stakeholder Input.--Before the initial rulemaking process to 
implement this section, the Secretary shall allow for stakeholder 
input, such as through town halls, open door forums, and mail-box 
submissions.
    ``(k) Funding.--For purposes of carrying out this section, the 
Secretary shall provide for the transfer to the Centers for Medicare & 
Medicaid Services Program Management Account, from the Federal Hospital 
Insurance Trust Fund under section 1817 and the Federal Supplementary 
Medical Insurance Trust Fund under section 1841, in such proportion as 
the Secretary determines appropriate, of $130,000,000. Fifty percent of 
such amount shall be available on the date of the enactment of this 
section and fifty percent of such amount shall be equally proportioned 
for each of fiscal years 2015 through 2019. Such sums shall remain 
available until expended.
    ``(l) Limitation.--There shall be no administrative or judicial 
review under sections 1869 and 1878 or otherwise of the specification 
of standardized patient assessment data required, the determination of 
measures, and the systems to report such standardized data under this 
section.
    ``(m) Non-Application of Paperwork Reduction Act.--Chapter 35 of 
title 44, United States Code (commonly referred to as the `Paperwork 
Reduction Act of 1995') shall not apply to this section and the 
sections referenced in subsection (a)(2)(B) that require modification 
in order to achieve the standardization of patient assessment data.''.
    (b) Studies of Alternative PAC Payment Models.--
        (1) MedPAC.--Using data from the Post-Acute Payment Reform 
    Demonstration authorized under section 5008 of the Deficit 
    Reduction Act of 2005 (Public Law 109-171) or other data, as 
    available, not later than June 30, 2016, the Medicare Payment 
    Advisory Commission shall submit to Congress a report that 
    evaluates and recommends features of PAC payment systems (as 
    defined in section 1899B(a)(2)(D) of the Social Security Act, as 
    added by subsection (a)) that establish, or a unified post-acute 
    care payment system under title XVIII of the Social Security Act 
    that establishes, payment rates according to characteristics of 
    individuals (such as cognitive ability, functional status, and 
    impairments) instead of according to the post-acute care setting 
    where the Medicare beneficiary involved is treated. To the extent 
    feasible, such report shall consider the impacts of moving from PAC 
    payment systems (as defined in subsection (a)(2)(D) of such section 
    1899B) in existence as of the date of the enactment of this Act to 
    new post-acute care payment systems under title XVIII of the Social 
    Security Act.
        (2) Recommendations for pac prospective payment.--
            (A) Report by secretary.--Not later than 2 years after the 
        date by which the Secretary of Health and Human Services has 
        collected 2 years of data on quality measures under subsection 
        (c) of section 1899B, as added by subsection (a), the Secretary 
        shall, in consultation with the Medicare Payment Advisory 
        Commission and appropriate stakeholders, submit to Congress a 
        report, including--
                (i) recommendations and a technical prototype, on a 
            post-acute care prospective payment system under title 
            XVIII of the Social Security Act that would--

                    (I) in lieu of the rates that would otherwise apply 
                under PAC payment systems (as defined in subsection 
                (a)(2)(D) of such section 1899B), base payments under 
                such title, with respect to items and services 
                furnished to an individual by a PAC provider (as 
                defined in subsection (a)(2)(A) of such section), 
                according to individual characteristics (such as 
                cognitive ability, functional status, and impairments) 
                of such individual instead of the post-acute care 
                setting in which the individual is furnished such items 
                and services;
                    (II) account for the clinical appropriateness of 
                items and services so furnished and Medicare 
                beneficiary outcomes;
                    (III) be designed to incorporate (or otherwise 
                account for) standardized patient assessment data under 
                section 1899B; and
                    (IV) further clinical integration, such as by 
                motivating greater coordination around a single 
                condition or procedure to integrate hospital systems 
                with PAC providers (as so defined).

                (ii) recommendations on which Medicare fee-for-service 
            regulations for post-acute care payment systems under title 
            XVIII of the Social Security Act should be altered (such as 
            the skilled nursing facility 3-day stay and inpatient 
            rehabilitation facility 60 percent rule);
                (iii) an analysis of the impact of the recommended 
            payment system described in clause (i) on Medicare 
            beneficiary cost-sharing, access to care, and choice of 
            setting;
                (iv) a projection of any potential reduction in 
            expenditures under title XVIII of the Social Security Act 
            that may be attributable to the application of the 
            recommended payment system described in clause (i); and
                (v) a review of the value of subsection (d) hospitals 
            (as defined in section 1886(d)(1)(B) of the Social Security 
            Act (42 U.S.C. 1395ww(d)(1)(B)), hospitals described in 
            section 1886(d)(1)(B)(v) of such Act (42 U.S.C. 
            1395ww(d)(1)(B)(v)), and critical access hospitals 
            described in section 1820(c)(2)(B) of such Act (42 U.S.C. 
            1395i-4(c)(2)(B)) collecting and reporting to the Secretary 
            standardized patient assessment data with respect to 
            inpatient hospital services furnished by such a hospital or 
            critical access hospital to individuals who are entitled to 
            benefits under part A of title XVIII of such Act or, as 
            appropriate, enrolled for benefits under part B of such 
            title.
            (B) Report by medpac.--Not later than the first June 30th 
        following the date on which the report is required under 
        subparagraph (A), the Medicare Payment Advisory Commission 
        shall submit to Congress a report, including recommendations 
        and a technical prototype, on a post-acute care prospective 
        payment system under title XVIII of the Social Security Act 
        that would satisfy the criteria described in subparagraph (A).
        (3) Medicare beneficiary defined.--For purposes of this 
    subsection, the term ``Medicare beneficiary'' has the meaning given 
    such term in section 1899B(a)(2) of the Social Security Act, as 
    added by subsection (a).
    (c) Payment Consequences Under the Applicable Reporting 
Provisions.--
        (1) Home health agencies.--Section 1895(b)(3)(B)(v) of the 
    Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is amended--
            (A) in subclause (I), by striking ``subclause (II)'' and 
        inserting ``subclauses (II) and (IV)'';
            (B) in subclause (II), by striking ``For 2007'' and 
        inserting ``Subject to subclause (V), for 2007'';
            (C) in subclause (III), by inserting ``and subclause 
        (IV)(aa)'' after ``subclause (II)''; and
            (D) by adding at the end the following new subclauses:

                    ``(IV) Submission of additional data.--

                        ``(aa) In general.--For the year beginning on 
                    the specified application date (as defined in 
                    subsection (a)(2)(E) of section 1899B), as 
                    applicable with respect to home health agencies and 
                    quality measures under subsection (c)(1) of such 
                    section and measures under subsection (d)(1) of 
                    such section, and each subsequent year, in addition 
                    to the data described in subclause (II), each home 
                    health agency shall submit to the Secretary data on 
                    such quality measures and any necessary data 
                    specified by the Secretary under such subsection 
                    (d)(1).
                        ``(bb) Standardized patient assessment data.--
                    For 2019 and each subsequent year, in addition to 
                    such data described in item (aa), each home health 
                    agency shall submit to the Secretary standardized 
                    patient assessment data required under subsection 
                    (b)(1) of section 1899B.
                        ``(cc) Submission.--Data shall be submitted 
                    under items (aa) and (bb) in the form and manner, 
                    and at the time, specified by the Secretary for 
                    purposes of this clause.

                    ``(V) Non-duplication.--To the extent data 
                submitted under subclause (IV) duplicates other data 
                required to be submitted under subclause (II), the 
                submission of such data under subclause (IV) shall be 
                in lieu of the submission of such data under subclause 
                (II). The previous sentence shall not apply insofar as 
                the Secretary determines it is necessary to avoid a 
                delay in the implementation of section 1899B, taking 
                into account the different specified application dates 
                under subsection (a)(2)(E) of such section.''.

        (2) Inpatient rehabilitation facilities.--Section 1886(j)(7) of 
    the Social Security Act (42 U.S.C. 1395ww(j)(7)) is amended--
            (A) in subparagraph (A)(i), by striking ``subparagraph 
        (C)'' and inserting ``subparagraphs (C) and (F)'';
            (B) in subparagraph (C), by striking ``For fiscal year 2014 
        and each subsequent rate year'' and inserting ``Subject to 
        subparagraph (G), for fiscal year 2014 and each subsequent 
        fiscal year'';
            (C) in subparagraph (E), by inserting ``and subparagraph 
        (F)(i)'' after ``subparagraph (C)''; and
            (D) by adding at the end the following new subparagraphs:
            ``(F) Submission of additional data.--
                ``(i) In general.--For the fiscal year beginning on the 
            specified application date (as defined in subsection 
            (a)(2)(E) of section 1899B), as applicable with respect to 
            inpatient rehabilitation facilities and quality measures 
            under subsection (c)(1) of such section and measures under 
            subsection (d)(1) of such section, and each subsequent 
            fiscal year, in addition to such data on the quality 
            measures described in subparagraph (C), each rehabilitation 
            facility shall submit to the Secretary data on the quality 
            measures under such subsection (c)(1) and any necessary 
            data specified by the Secretary under such subsection 
            (d)(1).
                ``(ii) Standardized patient assessment data.--For 
            fiscal year 2019 and each subsequent fiscal year, in 
            addition to such data described in clause (i), each 
            rehabilitation facility shall submit to the Secretary 
            standardized patient assessment data required under 
            subsection (b)(1) of section 1899B.
                ``(iii) Submission.--Such data shall be submitted in 
            the form and manner, and at the time, specified by the 
            Secretary for purposes of this subparagraph.
            ``(G) Non-duplication.--To the extent data submitted under 
        subparagraph (F) duplicates other data required to be submitted 
        under subparagraph (C), the submission of such data under 
        subparagraph (F) shall be in lieu of the submission of such 
        data under subparagraph (C). The previous sentence shall not 
        apply insofar as the Secretary determines it is necessary to 
        avoid a delay in the implementation of section 1899B, taking 
        into account the different specified application dates under 
        subsection (a)(2)(E) of such section.''.
        (3) Long-term care hospitals.--Section 1886(m)(5) of the Social 
    Security Act (42 U.S.C. 1395ww(m)(5)) is amended--
            (A) in subparagraph (A)(i), by striking ``subparagraph 
        (C)'' and inserting ``subparagraphs (C) and (F)'';
            (B) in subparagraph (C), by striking ``For rate year'' and 
        inserting ``Subject to subparagraph (G), for rate year'';
            (C) in subparagraph (E), by inserting ``and subparagraph 
        (F)(i)'' after ``subparagraph (C)''; and
            (D) by adding at the end the following new subparagraphs:
            ``(F) Submission of additional data.--
                ``(i) In general.--For the rate year beginning on the 
            specified application date (as defined in subsection 
            (a)(2)(E) of section 1899B), as applicable with respect to 
            long-term care hospitals and quality measures under 
            subsection (c)(1) of such section and measures under 
            subsection (d)(1) of such section, and each subsequent rate 
            year, in addition to the data on the quality measures 
            described in subparagraph (C), each long-term care hospital 
            (other than a hospital classified under subsection 
            (d)(1)(B)(iv)(II)) shall submit to the Secretary data on 
            the quality measures under such subsection (c)(1) and any 
            necessary data specified by the Secretary under such 
            subsection (d)(1).
                ``(ii) Standardized patient assessment data.--For rate 
            year 2019 and each subsequent rate year, in addition to 
            such data described in clause (i), each long-term care 
            hospital (other than a hospital classified under subsection 
            (d)(1)(B)(iv)(II)) shall submit to the Secretary 
            standardized patient assessment data required under 
            subsection (b)(1) of section 1899B.
                ``(iii) Submission.--Such data shall be submitted in 
            the form and manner, and at the time, specified by the 
            Secretary for purposes of this subparagraph.
            ``(G) Non-duplication.--To the extent data submitted under 
        subparagraph (F) duplicates other data required to be submitted 
        under subparagraph (C), the submission of such data under 
        subparagraph (F) shall be in lieu of the submission of such 
        data under subparagraph (C). The previous sentence shall not 
        apply insofar as the Secretary determines it is necessary to 
        avoid a delay in the implementation of section 1899B, taking 
        into account the different specified application dates under 
        subsection (a)(2)(E) of such section.''.
        (4) Skilled nursing facilities.--
            (A) In general.--Paragraph (6) of section 1888(e) of the 
        Social Security Act (42 U.S.C. 1395yy(e)) is amended to read as 
        follows:
        ``(6) Reporting of assessment and quality data.--
            ``(A) Reduction in update for failure to report.--
                ``(i) In general.--For fiscal years beginning with 
            fiscal year 2018, in the case of a skilled nursing facility 
            that does not submit data, as applicable, in accordance 
            with subclauses (II) and (III) of subparagraph (B)(i) with 
            respect to such a fiscal year, after determining the 
            percentage described in paragraph (5)(B)(i), and after 
            application of paragraph (5)(B)(ii), the Secretary shall 
            reduce such percentage for payment rates during such fiscal 
            year by 2 percentage points.
                ``(ii) Special rule.--The application of this 
            subparagraph may result in the percentage described in 
            paragraph (5)(B)(i), after application of paragraph 
            (5)(B)(ii), being less than 0.0 for a fiscal year, and may 
            result in payment rates under this subsection for a fiscal 
            year being less than such payment rates for the preceding 
            fiscal year.
                ``(iii) Noncumulative application.--Any reduction under 
            clause (i) shall apply only with respect to the fiscal year 
            involved and the Secretary shall not take into account such 
            reduction in computing the payment amount under this 
            subsection for a subsequent fiscal year.
            ``(B) Assessment and measure data.--
                ``(i) In general.--A skilled nursing facility, or a 
            facility (other than a critical access hospital) described 
            in paragraph (7)(B), shall submit to the Secretary, in a 
            manner and within the timeframes prescribed by the 
            Secretary--

                    ``(I) subject to clause (iii), the resident 
                assessment data necessary to develop and implement the 
                rates under this subsection;
                    ``(II) for fiscal years beginning on or after the 
                specified application date (as defined in subsection 
                (a)(2)(E) of section 1899B), as applicable with respect 
                to skilled nursing facilities and quality measures 
                under subsection (c)(1) of such section and measures 
                under subsection (d)(1) of such section, data on such 
                quality measures under such subsection (c)(1) and any 
                necessary data specified by the Secretary under such 
                subsection (d)(1); and
                    ``(III) for fiscal years beginning on or after 
                October 1, 2018, standardized patient assessment data 
                required under subsection (b)(1) of section 1899B.

                ``(ii) Use of standard instrument.--For purposes of 
            meeting the requirement under clause (i), a skilled nursing 
            facility, or a facility (other than a critical access 
            hospital) described in paragraph (7)(B), may submit the 
            resident assessment data required under section 1819(b)(3), 
            using the standard instrument designated by the State under 
            section 1819(e)(5).
                ``(iii) Non-duplication.--To the extent data submitted 
            under subclause (II) or (III) of clause (i) duplicates 
            other data required to be submitted under clause (i)(I), 
            the submission of such data under such a subclause shall be 
            in lieu of the submission of such data under clause (i)(I). 
            The previous sentence shall not apply insofar as the 
            Secretary determines it is necessary to avoid a delay in 
            the implementation of section 1899B, taking into account 
            the different specified application dates under subsection 
            (a)(2)(E) of such section.''.
            (B) Funding for nursing home compare website.--Section 
        1819(i) of the Social Security Act (42 U.S.C. 1395i-3(i)) is 
        amended by adding at the end the following new paragraph:
        ``(3) Funding.--The Secretary shall transfer to the Centers for 
    Medicare & Medicaid Services Program Management Account, from the 
    Federal Hospital Insurance Trust Fund under section 1817 a one-time 
    allocation of $11,000,000. The amount shall be available on the 
    date of the enactment of this paragraph. Such sums shall remain 
    available until expended. Such sums shall be used to implement 
    section 1128I(g).''.
    (d) Improving Payment Accuracy Under the PAC Payment Systems and 
Other Medicare Payment Systems.--
        (1) Studies and reports of effect of certain information on 
    quality and resource use.--
            (A) Study using existing medicare data.--
                (i) Study.--The Secretary of Health and Human Services 
            (in this subsection referred to as the ``Secretary'') shall 
            conduct a study that examines the effect of individuals' 
            socioeconomic status on quality measures and resource use 
            and other measures for individuals under the Medicare 
            program under title XVIII of the Social Security Act (42 
            U.S.C. 1395 et seq.) (such as to recognize that less 
            healthy individuals may require more intensive 
            interventions). The study shall use information collected 
            on such individuals in carrying out such program, such as 
            urban and rural location, eligibility for Medicaid under 
            title XIX of such Act (42 U.S.C. 1396 et seq.) (recognizing 
            and accounting for varying Medicaid eligibility across 
            States), and eligibility for benefits under the 
            supplemental security income (SSI) program. The Secretary 
            shall carry out this paragraph acting through the Assistant 
            Secretary for Planning and Evaluation.
                (ii) Report.--Not later than 2 years after the date of 
            the enactment of this Act, the Secretary shall submit to 
            Congress a report on the study conducted under clause (i).
            (B) Study using other data.--
                (i) Study.--The Secretary shall conduct a study that 
            examines the impact of risk factors, such as those 
            described in section 1848(p)(3) of the Social Security Act 
            (42 U.S.C. 1395w-4(p)(3)), race, health literacy, limited 
            English proficiency (LEP), and Medicare beneficiary 
            activation, on quality measures and resource use and other 
            measures under the Medicare program (such as to recognize 
            that less healthy individuals may require more intensive 
            interventions). In conducting such study the Secretary may 
            use existing Federal data and collect such additional data 
            as may be necessary to complete the study.
                (ii) Report.--Not later than 5 years after the date of 
            the enactment of this Act, the Secretary shall submit to 
            Congress a report on the study conducted under clause (i).
            (C) Examination of data in conducting studies.--In 
        conducting the studies under subparagraphs (A) and (B), the 
        Secretary shall examine what non-Medicare data sets, such as 
        data from the American Community Survey (ACS), can be useful in 
        conducting the types of studies under such paragraphs and how 
        such data sets that are identified as useful can be coordinated 
        with Medicare administrative data in order to improve the 
        overall data set available to do such studies and for the 
        administration of the Medicare program.
            (D) Recommendations to account for information in payment 
        adjustment mechanisms.--If the studies conducted under 
        subparagraphs (A) and (B) find a relationship between the 
        factors examined in the studies and quality measures and 
        resource use and other measures, then the Secretary shall also 
        provide recommendations for how the Centers for Medicare & 
        Medicaid Services should--
                (i) obtain access to the necessary data (if such data 
            is not already being collected) on such factors, including 
            recommendations on how to address barriers to the Centers 
            in accessing such data; and
                (ii) account for such factors--

                    (I) in quality measures, resource use measures, and 
                other measures under title XVIII of the Social Security 
                Act (including such measures specified under 
                subsections (c) and (d) of section 1899B of such Act, 
                as added by subsection (a)); and
                    (II) in determining payment adjustments based on 
                such measures in other applicable provisions of such 
                title.

            (E) Funding.--There are hereby appropriated to the 
        Secretary from the Federal Hospital Insurance Trust Fund under 
        section 1817 of the Social Security Act (42 U.S.C. 1395i) and 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 of such Act (42 U.S.C. 1395t) (in proportions 
        determined appropriate by the Secretary) to carry out this 
        paragraph $6,000,000, to remain available until expended.
        (2) CMS activities.--
            (A) In general.--Taking into account the relevant studies 
        conducted and recommendations made in reports under paragraph 
        (1) and, as appropriate, other information, including 
        information collected before completion of such studies and 
        recommendations, the Secretary, on an ongoing basis, shall, as 
        the Secretary determines appropriate and based on an 
        individual's health status and other factors--
                (i) assess appropriate adjustments to quality measures, 
            resource use measures, and other measures under title XVIII 
            of the Social Security Act (42 U.S.C. 1395 et seq.) 
            (including measures specified in subsections (c) and (d) of 
            section 1899B of such Act, as added by subsection (a)); and
                (ii) assess and implement appropriate adjustments to 
            payments under such title based on measures described in 
            clause (i).
            (B) Accessing data.--The Secretary shall collect or 
        otherwise obtain access to the data necessary to carry out this 
        paragraph through existing and new data sources.
            (C) Periodic analyses.--The Secretary shall carry out 
        periodic analyses, at least every 3 years, based on the factors 
        referred to in subparagraph (A) so as to monitor changes in 
        possible relationships.
            (D) Funding.--There are hereby appropriated to the 
        Secretary from the Federal Hospital Insurance Trust Fund under 
        section 1817 of the Social Security Act (42 U.S.C. 1395i) and 
        the Federal Supplementary Medical Insurance Trust Fund under 
        section 1841 of such Act (42 U.S.C. 1395t) (in proportions 
        determined appropriate by the Secretary) to carry out this 
        paragraph $10,000,000, to remain available until expended.
        (3) Strategic plan for accessing race and ethnicity data.--Not 
    later than 18 months after the date of the enactment of this Act, 
    the Secretary shall develop and report to Congress on a strategic 
    plan for collecting or otherwise accessing data on race and 
    ethnicity for purposes of specifying quality measures and resource 
    use and other measures under subsections (c) and (d) of section 
    1899B of the Social Security Act, as added by subsection (a), and, 
    as the Secretary determines appropriate, other similar provisions 
    of, including payment adjustments under, title XVIII of such Act 
    (42 U.S.C. 1395 et seq.).
SEC. 3. HOSPICE CARE.
    (a) Hospice Survey Requirement.--
        (1) In general.--Section 1861(dd)(4) of the Social Security Act 
    (42 U.S.C. 1395x(dd)(4)) is amended by adding at the end the 
    following new subparagraph:
    ``(C) Any entity that is certified as a hospice program shall be 
subject to a standard survey by an appropriate State or local survey 
agency, or an approved accreditation agency, as determined by the 
Secretary, not less frequently than once every 36 months beginning 6 
months after the date of the enactment of this subparagraph and ending 
September 30, 2025.''.
        (2) Funding.--For purposes of carrying out subparagraph (C) of 
    section 1861(dd)(4) of the Social Security Act (42 U.S.C. 
    1395x(dd)(4)), as added by paragraph (1), there shall be 
    transferred from the Federal Hospital Insurance Trust Fund under 
    section 1817 of such Act (42 U.S.C. 1395i) to the Centers for 
    Medicare & Medicaid Services Program Management Account--
            (A) $25,000,000 for fiscal years 2015 through 2017, to be 
        made available for such purposes in equal parts for each such 
        fiscal year; and
            (B) $45,000,000 for fiscal years 2018 through 2025, to be 
        made available for such purposes in equal parts for each such 
        fiscal year.
    (b) Hospice Program Eligibility Recertification Technical 
Correction to Apply Limitation on Liability of Beneficiary Rules.--
Section 1879 of the Social Security Act (42 U.S.C. 1395pp) is amended 
by adding at the end the following new subsection:
    ``(i) The provisions of this section shall apply with respect to a 
denial of a payment under this title by reason of section 1814(a)(7)(E) 
in the same manner as such provisions apply with respect to a denial of 
a payment under this title by reason of section 1862(a)(1).''.
    (c) Revision to Requirement for Medical Review of Certain Hospice 
Care.--Section 1814(a)(7) of the Social Security Act (42 U.S.C. 
1395f(a)(7)) is amended--
        (1) in subparagraph (C), by striking ``and'' at the end;
        (2) in subparagraph (D), in the matter preceding clause (i), by 
    inserting ``(and, in the case of clause (ii), before the date of 
    enactment of subparagraph (E))'' after ``2011''; and
        (3) by adding at the end the following new subparagraph:
            ``(E) on and after the date of enactment of this 
        subparagraph, in the case of hospice care provided an 
        individual for more than 180 days by a hospice program for 
        which the number of such cases for such program comprises more 
        than a percent (specified by the Secretary) of the total number 
        of all cases of individuals provided hospice care by the 
        program under this title, the hospice care provided to such 
        individual is medically reviewed (in accordance with procedures 
        established by the Secretary); and''.
    (d) Update of Hospice Aggregate Payment Cap.--Section 1814(i)(2)(B) 
of the Social Security Act (42 U.S.C. 1395f(i)(2)(B)) is amended--
        (1) by striking ``(B) For purposes'' and inserting ``(B)(i) 
    Except as provided in clause (ii), for purposes''; and
        (2) by adding at the end the following:
    ``(ii) For purposes of subparagraph (A) for accounting years that 
end after September 30, 2016, and before October 1, 2025, the `cap 
amount' is the cap amount under this subparagraph for the preceding 
accounting year updated by the percentage update to payment rates for 
hospice care under paragraph (1)(C) for services furnished during the 
fiscal year beginning on the October 1 preceding the beginning of the 
accounting year (including the application of any productivity or other 
adjustment under clause (iv) of that paragraph).
    ``(iii) For accounting years that end after September 30, 2025, the 
cap amount shall be computed under clause (i) as if clause (ii) had 
never applied.''.
    (e) Medicare Improvement Fund.--Section 1898 of the Social Security 
Act (42 U.S.C. 1395iii) is amended--
        (1) by amending the heading to read as follows: ``medicare 
    improvement fund'';
        (2) by amending subsection (a) to read as follows:
    ``(a) Establishment.--The Secretary shall establish under this 
title a Medicare Improvement Fund (in this section referred to as the 
`Fund') which shall be available to the Secretary to make improvements 
under the original Medicare fee-for-service program under parts A and B 
for individuals entitled to, or enrolled for, benefits under part or 
enrolled under part B including adjustments to payments for items and 
services furnished by providers of services and suppliers under such 
original Medicare fee-for-service program.'';
        (3) in subsection (b)(1), by striking ``during'' and all that 
    follows and inserting ``during and after fiscal year 2020, 
    $195,000,000.''; and
        (4) in subsection (b)(2), by striking ``from the Federal'' and 
    all that follows and inserting ``from the Federal Hospital 
    Insurance Trust Fund and the Federal Supplementary Medical 
    Insurance Trust Fund in such proportion as the Secretary determines 
    appropriate.''.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```