113TH CONGRESS 

2D SESSION H. R. 4994 

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. 

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

2 This Act may be cited as the ‘‘Improving Medicare 

3 Post-Acute Care Transformation Act of 2014’’ or the 

4 ‘‘IMPACT Act of 2014’’. 

5 SEC. 2. STANDARDIZATION OF POST-ACUTE CARE DATA. 

6 (a) IN GENERAL.—Title XVIII of the Social Security 

7 Act is amended by adding at the end the following new 

8 section: 

9 ‘‘SEC. 1899B. STANDARDIZED POST-ACUTE CARE (PAC) AS10 SESSMENT DATA FOR QUALITY, PAYMENT, 

11 AND DISCHARGE PLANNING. 

12 ‘‘(a) REQUIREMENT FOR STANDARDIZED ASSESS13 MENT DATA.— 

14 ‘‘(1) IN GENERAL.—The Secretary shall— 

15 ‘‘(A) require under the applicable reporting 

16 provisions post-acute care providers (as defined 

17 in paragraph (2)(A)) to report— 

18 ‘‘(i) standardized patient assessment 

19 data in accordance with subsection (b); 

20 ‘‘(ii) data on quality measures under 

21 subsection (c)(1); and 

22 ‘‘(iii) data on resource use and other 

23 measures under subsection (d)(1); 

24 ‘‘(B) require data described in subpara25 graph (A) to be standardized and interoperable 

26 so as to allow for the exchange of such data 
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1 among such post-acute care providers and other 

2 providers and the use by such providers of such 

3 data that has been so exchanged, including by 

4 using common standards and definitions, in 

5 order to provide access to longitudinal informa6 tion for such providers to facilitate coordinated 

7 care and improved Medicare beneficiary out8 comes; and 

9 ‘‘(C) in accordance with subsections (b)(1) 

10 and (c)(2), modify PAC assessment instruments 

11 (as defined in paragraph (2)(B)) applicable to 

12 post-acute care providers to— 

13 ‘‘(i) provide for the submission of 

14 standardized patient assessment data 

15 under this title with respect to such pro16 viders; and 

17 ‘‘(ii) enable comparison of such as18 sessment data across all such providers to 

19 whom such data are applicable. 

20 ‘‘(2) DEFINITIONS.—For purposes of this sec21 tion: 

22 ‘‘(A) POST-ACUTE CARE (PAC) PRO23 VIDER.—The terms ‘post-acute care provider’ 

24 and ‘PAC provider’ mean— 

25 ‘‘(i) a home health agency; 
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1 ‘‘(ii) a skilled nursing facility; 

2 ‘‘(iii) an inpatient rehabilitation facil3 ity; and 

4 ‘‘(iv) a long-term care hospital (other 

5 than a hospital classified under section 

6 1886(d)(1)(B)(iv)(II)). 

7 ‘‘(B) PAC ASSESSMENT INSTRUMENT.— 

8 The term ‘PAC assessment instrument’ 

9 means— 

10 ‘‘(i) in the case of home health agen11 cies, the instrument used for purposes of 

12 reporting and assessment with respect to 

13 the Outcome and Assessment Information 

14 Set (OASIS), as described in sections 

15 484.55 and 484.250 of title 42, the Code 

16 of Federal Regulations, or any successor 

17 regulation, or any other instrument used 

18 with respect to home health agencies for 

19 such purposes; 

20 ‘‘(ii) in the case of skilled nursing fa21 cilities, the resident’s assessment under 

22 section 1819(b)(3); 

23 ‘‘(iii) in the case of inpatient rehabili24 tation facilities, any Medicare beneficiary 

25 assessment instrument established by the 
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1 Secretary for purposes of section 1886(j); 

2 and 

3 ‘‘(iv) in the case of long-term care 

4 hospitals, the Medicare beneficiary assess5 ment instrument used with respect to such 

6 hospitals for the collection of data elements 

7 necessary to calculate quality measures as 

8 described in the August 18, 2011, Federal 

9 Register (76 Fed. Reg. 51754–51755), in10 cluding for purposes of section 

11 1886(m)(5)(C), or any other instrument 

12 used with respect to such hospitals for as13 sessment purposes. 

14 ‘‘(C) APPLICABLE REPORTING PROVI15 SION.—The term ‘applicable reporting provi16 sion’ means— 

17 ‘‘(i) for home health agencies, section 

18 1895(b)(3)(B)(v); 

19 ‘‘(ii) for skilled nursing facilities, sec20 tion 1888(e)(6); 

21 ‘‘(iii) for inpatient rehabilitation facili22 ties, section 1886(j)(7); and 

23 ‘‘(iv) for long-term care hospitals, sec24 tion 1886(m)(5). 
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1 ‘‘(D) PAC PAYMENT SYSTEM.—The term 

2 ‘PAC payment system’ means— 

3 ‘‘(i) with respect to a home health 

4 agency, the prospective payment system 

5 under section 1895; 

6 ‘‘(ii) with respect to a skilled nursing 

7 facility, the prospective payment system 

8 under section 1888(e); 

9 ‘‘(iii) with respect to an inpatient re10 habilitation facility, the prospective pay11 ment system under section 1886(j); and 

12 ‘‘(iv) with respect to a long-term care 

13 hospital, the prospective payment system 

14 under section 1886(m). 

15 ‘‘(E) SPECIFIED APPLICATION DATE.—The 

16 term ‘specified application date’ means the fol17 lowing: 

18 ‘‘(i) QUALITY MEASURES.—In the 

19 case of quality measures under subsection 

20 (c)(1)— 

21 ‘‘(I) with respect to the domain 

22 described in subsection (c)(1)(A) (re23 lating to functional status, cognitive 

24 function, and changes in function and 

25 cognitive function)— 
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1 ‘‘(aa) for PAC providers de2 scribed in clauses (ii) and (iii) of 

3 paragraph (2)(A), October 1, 

4 2016; 

5 ‘‘(bb) for PAC providers de6 scribed in clause (iv) of such 

7 paragraph, October 1, 2018; and 

8 ‘‘(cc) for PAC providers de9 scribed in clause (i) of such para10 graph, January 1, 2019; 

11 ‘‘(II) with respect to the domain 

12 described in subsection (c)(1)(B) (re13 lating to skin integrity and changes in 

14 skin integrity)— 

15 ‘‘(aa) for PAC providers de16 scribed in clauses (ii), (iii), and 

17 (iv) of paragraph (2)(A), October 

18 1, 2016; and 

19 ‘‘(bb) for PAC providers de20 scribed in clause (i) of such para21 graph, January 1, 2017; 

22 ‘‘(III) with respect to the domain 

23 described in subsection (c)(1)(C) (re24 lating to medication reconciliation)— 
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1 ‘‘(aa) for PAC providers de2 scribed in clause (i) of such para3 graph, January 1, 2017; and 

4 ‘‘(bb) for PAC providers de5 scribed in clauses (ii), (iii), and 

6 (iv) of such paragraph, October 

7 1, 2018; 

8 ‘‘(IV) with respect to the domain 

9 described in subsection (c)(1)(D) (re10 lating to incidence of major falls)— 

11 ‘‘(aa) for PAC providers de12 scribed in clauses (ii), (iii), and 

13 (iv) of paragraph (2)(A), October 

14 1, 2016; and 

15 ‘‘(bb) for PAC providers de16 scribed in clause (i) of such para17 graph, January 1, 2019; and 

18 ‘‘(V) with respect to the domain 

19 described in subsection (c)(1)(E) (re20 lating to accurately communicating 

21 the existence of and providing for the 

22 transfer of health information and 

23 care preferences)— 

24 ‘‘(aa) for PAC providers de25 scribed in clauses (ii), (iii), and 
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1 (iv) of paragraph (2)(A), October 

2 1, 2018; and 

3 ‘‘(bb) for PAC providers de4 scribed in clause (i) of such para5 graph, January 1, 2019. 

6 ‘‘(ii) RESOURCE USE AND OTHER

7 MEASURES.—In the case of resource use 

8 and other measures under subsection 

9 (d)(1)— 

10 ‘‘(I) for PAC providers described 

11 in clauses (ii), (iii), and (iv) of para12 graph (2)(A), October 1, 2016; and 

13 ‘‘(II) for PAC providers de14 scribed in clause (i) of such para15 graph, January 1, 2017. 

16 ‘‘(F) MEDICARE BENEFICIARY.—The term 

17 ‘Medicare beneficiary’ means an individual enti18 tled to benefits under part A or, as appropriate, 

19 enrolled for benefits under part B. 

20 ‘‘(b) STANDARDIZED PATIENT ASSESSMENT DATA.— 

21 ‘‘(1) REQUIREMENT FOR REPORTING ASSESS22 MENT DATA.— 

23 ‘‘(A) IN GENERAL.—Beginning not later 

24 than October 1, 2018, for PAC providers de25 scribed in clauses (ii), (iii), and (iv) of sub-
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1 section (a)(2)(A) and January 1, 2019, for 

2 PAC providers described in clause (i) of such 

3 subsection, the Secretary shall require PAC 

4 providers to submit to the Secretary, under the 

5 applicable reporting provisions and through the 

6 use of PAC assessment instruments, the stand7 ardized patient assessment data described in 

8 subparagraph (B). The Secretary shall require 

9 such data be submitted with respect to admis10 sion and discharge of an individual (and may be 

11 submitted more frequently as the Secretary 

12 deems appropriate). 

13 ‘‘(B) STANDARDIZED PATIENT ASSESS14 MENT DATA DESCRIBED.—For purposes of sub15 paragraph (A), the standardized patient assess16 ment data described in this subparagraph is 

17 data required for at least the quality measures 

18 described in subsection (c)(1) and that is with 

19 respect to the following categories: 

20 ‘‘(i) Functional status, such as mobil21 ity and self care at admission to a PAC 

22 provider and before discharge from a PAC 

23 provider. 

24 ‘‘(ii) Cognitive function, such as abil25 ity to express ideas and to understand, and 
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1 mental status, such as depression and de2 mentia. 

3 ‘‘(iii) Special services, treatments, and 

4 interventions, such as need for ventilator 

5 use, dialysis, chemotherapy, central line 

6 placement, and total parenteral nutrition. 

7 ‘‘(iv) Medical conditions and co8 morbidities, such as diabetes, congestive 

9 heart failure, and pressure ulcers. 

10 ‘‘(v) Impairments, such as inconti11 nence and an impaired ability to hear, see, 

12 or swallow. 

13 ‘‘(vi) Other categories deemed nec14 essary and appropriate by the Secretary. 

15 ‘‘(2) ALIGNMENT OF CLAIMS DATA WITH

16 STANDARDIZED PATIENT ASSESSMENT DATA.—To 

17 the extent practicable, not later than October 1, 

18 2018, for PAC providers described in clauses (ii), 

19 (iii), and (iv) of subsection (a)(2)(A), and January 

20 1, 2019, for PAC providers described in clause (i) of 

21 such subsection, the Secretary shall match claims 

22 data with assessment data pursuant to this section 

23 for purposes of assessing prior service use and con24 current service use, such as antecedent hospital or 

25 PAC provider use, and may use such matched data 
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1 for such other uses as the Secretary determines ap2 propriate. 

3 ‘‘(3) REPLACEMENT OF CERTAIN EXISTING

4 DATA.—In the case of patient assessment data being 

5 used with respect to a PAC assessment instrument 

6 that duplicates or overlaps with standardized patient 

7 assessment data within a category described in para8 graph (1), the Secretary shall, as soon as prac9 ticable, revise or replace such existing data with the 

10 standardized data. 

11 ‘‘(4) CLARIFICATION.—Standardized patient as12 sessment data submitted pursuant to this subsection 

13 shall not be used to require individuals to be pro14 vided post-acute care by a specific type of PAC pro15 vider in order for such care to be eligible for pay16 ment under this title. 

17 ‘‘(c) QUALITY MEASURES.— 

18 ‘‘(1) REQUIREMENT FOR REPORTING QUALITY

19 MEASURES.—Not later than the specified application 

20 date, as applicable to measures and PAC providers, 

21 the Secretary shall specify quality measures on 

22 which PAC providers are required under the applica23 ble reporting provisions to submit standardized pa24 tient assessment data described in subsection (b)(1) 

25 and other necessary data specified by the Secretary. 
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1 Such measures shall be with respect to at least the 

2 following domains: 

3 ‘‘(A) Functional status, cognitive function, 

4 and changes in function and cognitive function. 

5 ‘‘(B) Skin integrity and changes in skin in6 tegrity. 

7 ‘‘(C) Medication reconciliation. 

8 ‘‘(D) Incidence of major falls. 

9 ‘‘(E) Accurately communicating the exist10 ence of and providing for the transfer of health 

11 information and care preferences of an indi12 vidual to the individual, family caregiver of the 

13 individual, and providers of services furnishing 

14 items and services to the individual, when the 

15 individual transitions— 

16 ‘‘(i) from a hospital or critical access 

17 hospital to another applicable setting, in18 cluding a PAC provider or the home of the 

19 individual; or 

20 ‘‘(ii) from a PAC provider to another 

21 applicable setting, including a different 

22 PAC provider, a hospital, a critical access 

23 hospital, or the home of the individual. 

24 ‘‘(2) REPORTING THROUGH PAC ASSESSMENT

25 INSTRUMENTS.— 
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1 ‘‘(A) IN GENERAL.—To the extent pos2 sible, the Secretary shall require such reporting 

3 by a PAC provider of quality measures under 

4 paragraph (1) through the use of a PAC assess5 ment instrument and shall modify such PAC 

6 assessment instrument as necessary to enable 

7 the use of such instrument with respect to such 

8 quality measures. 

9 ‘‘(B) LIMITATION.—The Secretary may 

10 not make significant modifications to a PAC as11 sessment instrument more than once per cal12 endar year or fiscal year, as applicable, unless 

13 the Secretary publishes in the Federal Register 

14 a justification for such significant modification. 

15 ‘‘(3) ADJUSTMENTS.— 

16 ‘‘(A) IN GENERAL.—The Secretary shall 

17 consider applying adjustments to the quality 

18 measures under this subsection taking into con19 sideration the studies under section 2(d) of the 

20 IMPACT Act of 2014. 

21 ‘‘(B) RISK ADJUSTMENT.—Such quality 

22 measures shall be risk adjusted, as determined 

23 appropriate by the Secretary. 

24 ‘‘(d) RESOURCE USE AND OTHER MEASURES.— 
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1 ‘‘(1) REQUIREMENT FOR RESOURCE USE AND

2 OTHER MEASURES.—Not later than the specified ap3 plication date, as applicable to measures and PAC 

4 providers, the Secretary shall specify resource use 

5 and other measures on which PAC providers are re6 quired under the applicable reporting provisions to 

7 submit any necessary data specified by the Sec8 retary, which may include standardized assessment 

9 data in addition to claims data. Such measures shall 

10 be with respect to at least the following domains: 

11 ‘‘(A) Resource use measures, including 

12 total estimated Medicare spending per bene13 ficiary. 

14 ‘‘(B) Discharge to community. 

15 ‘‘(C) Measures to reflect all-condition risk16 adjusted potentially preventable hospital read17 mission rates. 

18 ‘‘(2) ALIGNING METHODOLOGY ADJUSTMENTS

19 FOR RESOURCE USE MEASURES.— 

20 ‘‘(A) PERIOD OF TIME.—With respect to 

21 the period of time used for calculating measures 

22 under paragraph (1)(A), the Secretary shall, to 

23 the extent the Secretary determines appro24 priate, align resource use with the methodology 

25 used for purposes of section 1886(o)(2)(B)(ii). 
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1 ‘‘(B) GEOGRAPHIC AND OTHER ADJUST2 MENTS.—The Secretary shall standardize meas3 ures with respect to the domain described in 

4 paragraph (1)(A) for geographic payment rate 

5 differences and payment differentials (and other 

6 adjustments, as applicable) consistent with the 

7 methodology published in the Federal Register 

8 on August 18, 2011 (76 Fed. Reg. 51624 

9 through 51626), or any subsequent modifica10 tions made to the methodology. 

11 ‘‘(C) MEDICARE SPENDING PER BENE12 FICIARY.—The Secretary shall adjust, as appro13 priate, measures with respect to the domain de14 scribed in paragraph (1)(A) for the factors ap15 plied under section 1886(o)(2)(B)(ii). 

16 ‘‘(3) ADJUSTMENTS.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 consider applying adjustments to the resource 

19 use and other measures specified under this 

20 subsection with respect to the domain described 

21 in paragraph (1)(A), taking into consideration 

22 the studies under section 2(d) of the IMPACT 

23 Act of 2014. 
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1 ‘‘(B) RISK ADJUSTMENT.—Such resource 

2 use and other measures shall be risk adjusted, 

3 as determined appropriate by the Secretary. 

4 ‘‘(e) MEASUREMENT IMPLEMENTATION PHASES; SE5 LECTION OF QUALITY MEASURES AND RESOURCE USE

6 AND OTHER MEASURES.— 

7 ‘‘(1) MEASUREMENT IMPLEMENTATION

8 PHASES.—In the case of quality measures specified 

9 under subsection (c)(1) and resource use and other 

10 measures specified under subsection (d)(1), the pro11 visions of this section shall be implemented in ac12 cordance with the following phases: 

13 ‘‘(A) INITIAL IMPLEMENTATION PHASE.— 

14 The initial implementation phase, with respect 

15 to such a measure, shall, in accordance with 

16 subsections (c) and (d), as applicable, consist 

17 of— 

18 ‘‘(i) measure specification, including 

19 informing the public of the measure’s nu20 merator, denominator, exclusions, and any 

21 other aspects the Secretary determines 

22 necessary; 

23 ‘‘(ii) data collection, including, in the 

24 case of quality measures, requiring PAC 
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1 providers to report data elements needed 

2 to calculate such a measure; and 

3 ‘‘(iii) data analysis, including, in the 

4 case of resource use and other measures, 

5 the use of claims data to calculate such a 

6 measure. 

7 ‘‘(B) SECOND IMPLEMENTATION PHASE.— 

8 The second implementation phase, with respect 

9 to such a measure, shall consist of the provision 

10 of feedback reports to PAC providers, in ac11 cordance with subsection (f). 

12 ‘‘(C) THIRD IMPLEMENTATION PHASE.— 

13 The third implementation phase, with respect to 

14 such a measure, shall consist of public reporting 

15 of PAC providers’ performance on such meas16 ure in accordance with subsection (g). 

17 ‘‘(2) CONSENSUS-BASED ENTITY.— 

18 ‘‘(A) IN GENERAL.—Subject to subpara19 graph (B), each measure specified by the Sec20 retary under this section shall be endorsed by 

21 the entity with a contract under section 

22 1890(a). 

23 ‘‘(B) EXCEPTION.—In the case of a speci24 fied area or medical topic determined appro25 priate by the Secretary for which a feasible and 
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1 practical measure has not been endorsed by the 

2 entity with a contract under section 1890(a), 

3 the Secretary may specify a measure that is not 

4 so endorsed as long as due consideration is 

5 given to measures that have been endorsed or 

6 adopted by a consensus organization identified 

7 by the Secretary. 

8 ‘‘(3) TREATMENT OF APPLICATION OF PRE9 RULEMAKING PROCESS (MEASURE APPLICATIONS

10 PARTNERSHIP PROCESS).— 

11 ‘‘(A) IN GENERAL.—Subject to subpara12 graph (B), the provisions of section 1890A shall 

13 apply in the case of a quality measure specified 

14 under subsection (c) or a resource use or other 

15 measure specified under subsection (d). 

16 ‘‘(B) EXCEPTIONS.— 

17 ‘‘(i) EXPEDITED PROCEDURES.—For 

18 purposes of satisfying subparagraph (A), 

19 the Secretary may use expedited proce20 dures, such as ad-hoc reviews, as nec21 essary, in the case of a quality measure 

22 specified under subsection (c) or a resource 

23 use or other measure specified in sub24 section (d) required with respect to data 

25 submissions under the applicable reporting 
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1 provisions during the 1-year period before 

2 the specified application date applicable to 

3 such a measure and provider involved. 

4 ‘‘(ii) OPTION TO WAIVE PROVI5 SIONS.—The Secretary may waive the ap6 plication of the provisions of section 1890A 

7 in the case of a quality measure or re8 source use or other measure described in 

9 clause (i), if the application of such provi10 sions (including through the use of an ex11 pedited procedure described in such clause) 

12 would result in the inability of the Sec13 retary to satisfy any deadline specified in 

14 this section with respect to such measure. 

15 ‘‘(f) FEEDBACK REPORTS TO PAC PROVIDERS.— 

16 ‘‘(1) IN GENERAL.—Beginning one year after 

17 the specified application date, as applicable to PAC 

18 providers and quality measures and resource use and 

19 other measures under this section, the Secretary 

20 shall provide confidential feedback reports to such 

21 PAC providers on the performance of such providers 

22 with respect to such measures required under the 

23 applicable provisions. 

24 ‘‘(2) FREQUENCY.—To the extent feasible, the 

25 Secretary shall provide feedback reports described in 
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1 paragraph (1) not less frequently than on a quar2 terly basis. Notwithstanding the previous sentence, 

3 with respect to measures described in such para4 graph that are reported on an annual basis, the Sec5 retary may provide such feedback reports on an an6 nual basis. 

7 ‘‘(g) PUBLIC REPORTING OF PAC PROVIDER PER8 FORMANCE.— 

9 ‘‘(1) IN GENERAL.—Subject to the succeeding 

10 paragraphs of this subsection, the Secretary shall 

11 provide for public reporting of PAC provider per12 formance on quality measures under subsection 

13 (c)(1) and the resource use and other measures 

14 under subsection (d)(1), including by establishing 

15 procedures for making available to the public infor16 mation regarding the performance of individual PAC 

17 providers with respect to such measures. 

18 ‘‘(2) OPPORTUNITY TO REVIEW.—The proce19 dures under paragraph (1) shall ensure, including 

20 through a process consistent with the process ap21 plied under section 1886(b)(3)(B)(viii)(VII) for simi22 lar purposes, that a PAC provider has the oppor23 tunity to review and submit corrections to the data 

24 and information that is to be made public with re-
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1 spect to the provider prior to such data being made 

2 public. 

3 ‘‘(3) TIMING.—Such procedures shall provide 

4 that the data and information described in para5 graph (1), with respect to a measure and PAC pro6 vider, is made publicly available beginning not later 

7 than two years after the specified application date 

8 applicable to such a measure and provider. 

9 ‘‘(4) COORDINATION WITH EXISTING PRO10 GRAMS.—Such procedures shall provide that data 

11 and information described in paragraph (1) with re12 spect to quality measures and resource use and 

13 other measures under subsections (c)(1) and (d)(1) 

14 shall be made publicly available consistent with the 

15 following provisions: 

16 ‘‘(A) In the case of home health agencies, 

17 section 1895(b)(3)(B)(v)(III). 

18 ‘‘(B) In the case of skilled nursing facili19 ties, sections 1819(i) and 1919(i). 

20 ‘‘(C) In the case of inpatient rehabilitation 

21 facilities, section 1886(j)(7)(E). 

22 ‘‘(D) In the case of long-term care hos23 pitals, section 1886(m)(5)(E). 

24 ‘‘(h) REMOVING, SUSPENDING, OR ADDING MEAS25 URES.— 
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1 ‘‘(1) IN GENERAL.—The Secretary may remove, 

2 suspend, or add a quality measure or resource use 

3 or other measure described in subsection (c)(1) or 

4 (d)(1), so long as, subject to paragraph (2), the Sec5 retary publishes in the Federal Register (with a no6 tice and comment period) a justification for such re7 moval, suspension, or addition. 

8 ‘‘(2) EXCEPTION.—In the case of such a quality 

9 measure or resource use or other measure for which 

10 there is a reason to believe that the continued collec11 tion of such measure raises potential safety concerns 

12 or would cause other unintended consequences, the 

13 Secretary may promptly suspend or remove such 

14 measure and satisfy paragraph (1) by publishing in 

15 the Federal Register a justification for such suspen16 sion or removal in the next rulemaking cycle fol17 lowing such suspension or removal. 

18 ‘‘(i) USE OF STANDARDIZED ASSESSMENT DATA, 

19 QUALITY MEASURES, AND RESOURCE USE AND OTHER

20 MEASURES TO INFORM DISCHARGE PLANNING AND IN21 CORPORATE PATIENT PREFERENCE.— 

22 ‘‘(1) IN GENERAL.—Not later than January 1, 

23 2016, and periodically thereafter (but not less fre24 quently than once every 5 years), the Secretary shall 

25 promulgate regulations to modify conditions of par-
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1 ticipation and subsequent interpretive guidance ap2 plicable to PAC providers, hospitals, and critical ac3 cess hospitals. Such regulations and interpretive 

4 guidance shall require such providers to take into 

5 account quality, resource use, and other measures 

6 under the applicable reporting provisions (which, as 

7 available, shall include measures specified under sub8 sections (c) and (d), and other relevant measures) in 

9 the discharge planning process. Specifically, such 

10 regulations and interpretive guidance shall address 

11 the settings to which a patient may be discharged in 

12 order to assist subsection (d) hospitals, critical ac13 cess hospitals, hospitals described in section 

14 1886(d)(1)(B)(v), PAC providers, patients, and fam15 ilies of such patients with discharge planning from 

16 inpatient settings, including such hospitals, and 

17 from PAC provider settings. In addition, such regu18 lations and interpretive guidance shall include proce19 dures to address— 

20 ‘‘(A) treatment preferences of patients; 

21 and 

22 ‘‘(B) goals of care of patients. 

23 ‘‘(2) DISCHARGE PLANNING.—All requirements 

24 applied pursuant to paragraph (1) shall be used to 
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1 help inform and mandate the discharge planning 

2 process. 

3 ‘‘(3) CLARIFICATION.—Such regulations shall 

4 not require an individual to be provided post-acute 

5 care by a specific type of PAC provider in order for 

6 such care to be eligible for payment under this title. 

7 ‘‘(j) STAKEHOLDER INPUT.—Before the initial rule8 making process to implement this section, the Secretary 

9 shall allow for stakeholder input, such as through town 

10 halls, open door forums, and mail-box submissions. 

11 ‘‘(k) FUNDING.—For purposes of carrying out this 

12 section, the Secretary shall provide for the transfer to the 

13 Centers for Medicare & Medicaid Services Program Man14 agement Account, from the Federal Hospital Insurance 

15 Trust Fund under section 1817 and the Federal Supple16 mentary Medical Insurance Trust Fund under section 

17 1841, in such proportion as the Secretary determines ap18 propriate, of $130,000,000. Fifty percent of such amount 

19 shall be available on the date of the enactment of this sec20 tion and fifty percent of such amount shall be equally pro21 portioned for each of fiscal years 2015 through 2019. 

22 Such sums shall remain available until expended. 

23 ‘‘(l) LIMITATION.—There shall be no administrative 

24 or judicial review under sections 1869 and 1878 or other25 wise of the specification of standardized patient assess-
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1 ment data required, the determination of measures, and 

2 the systems to report such standardized data under this 

3 section. 

4 ‘‘(m) NON-APPLICATION OF PAPERWORK REDUC5 TION ACT.—Chapter 35 of title 44, United States Code 

6 (commonly referred to as the ‘Paperwork Reduction Act 

7 of 1995’) shall not apply to this section and the sections 

8 referenced in subsection (a)(2)(B) that require modifica9 tion in order to achieve the standardization of patient as10 sessment data.’’. 

11 (b) STUDIES OF ALTERNATIVE PAC PAYMENT MOD12 ELS.— 

13 (1) MEDPAC.—Using data from the Post14 Acute Payment Reform Demonstration authorized 

15 under section 5008 of the Deficit Reduction Act of 

16 2005 (Public Law 109–171) or other data, as avail17 able, not later than June 30, 2016, the Medicare 

18 Payment Advisory Commission shall submit to Con19 gress a report that evaluates and recommends fea20 tures of PAC payment systems (as defined in section 

21 1899B(a)(2)(D) of the Social Security Act, as added 

22 by subsection (a)) that establish, or a unified post23 acute care payment system under title XVIII of the 

24 Social Security Act that establishes, payment rates 

25 according to characteristics of individuals (such as 
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1 cognitive ability, functional status, and impairments) 

2 instead of according to the post-acute care setting 

3 where the Medicare beneficiary involved is treated. 

4 To the extent feasible, such report shall consider the 

5 impacts of moving from PAC payment systems (as 

6 defined in subsection (a)(2)(D) of such section 

7 1899B) in existence as of the date of the enactment 

8 of this Act to new post-acute care payment systems 

9 under title XVIII of the Social Security Act. 

10 (2) RECOMMENDATIONS FOR PAC PROSPECTIVE

11 PAYMENT.— 

12 (A) REPORT BY SECRETARY.—Not later 

13 than 2 years after the date by which the Sec14 retary of Health and Human Services has col15 lected 2 years of data on quality measures 

16 under subsection (c) of section 1899B, as added 

17 by subsection (a), the Secretary shall, in con18 sultation with the Medicare Payment Advisory 

19 Commission and appropriate stakeholders, sub20 mit to Congress a report, including— 

21 (i) recommendations and a technical 

22 prototype, on a post-acute care prospective 

23 payment system under title XVIII of the 

24 Social Security Act that would— 
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1 (I) in lieu of the rates that would 

2 otherwise apply under PAC payment 

3 systems (as defined in subsection 

4 (a)(2)(D) of such section 1899B), 

5 base payments under such title, with 

6 respect to items and services fur7 nished to an individual by a PAC pro8 vider (as defined in subsection 

9 (a)(2)(A) of such section), according 

10 to individual characteristics (such as 

11 cognitive ability, functional status, 

12 and impairments) of such individual 

13 instead of the post-acute care setting 

14 in which the individual is furnished 

15 such items and services; 

16 (II) account for the clinical ap17 propriateness of items and services so 

18 furnished and Medicare beneficiary 

19 outcomes; 

20 (III) be designed to incorporate 

21 (or otherwise account for) standard22 ized patient assessment data under 

23 section 1899B; and 

24 (IV) further clinical integration, 

25 such as by motivating greater coordi-
29 

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1 nation around a single condition or 

2 procedure to integrate hospital sys3 tems with PAC providers (as so de4 fined). 

5 (ii) recommendations on which Medi6 care fee-for-service regulations for post7 acute care payment systems under title 

8 XVIII of the Social Security Act should be 

9 altered (such as the skilled nursing facility 

10 3-day stay and inpatient rehabilitation fa11 cility 60 percent rule); 

12 (iii) an analysis of the impact of the 

13 recommended payment system described in 

14 clause (i) on Medicare beneficiary cost15 sharing, access to care, and choice of set16 ting; 

17 (iv) a projection of any potential re18 duction in expenditures under title XVIII 

19 of the Social Security Act that may be at20 tributable to the application of the rec21 ommended payment system described in 

22 clause (i); and 

23 (v) a review of the value of subsection 

24 (d) hospitals (as defined in section 

25 1886(d)(1)(B) of the Social Security Act 
30 

•HR 4994 EH

1 (42 U.S.C. 1395ww(d)(1)(B)), hospitals 

2 described in section 1886(d)(1)(B)(v) of 

3 such Act (42 U.S.C. 1395ww(d)(1)(B)(v)), 

4 and critical access hospitals described in 

5 section 1820(c)(2)(B) of such Act (42 

6 U.S.C. 1395i–4(c)(2)(B)) collecting and 

7 reporting to the Secretary standardized pa8 tient assessment data with respect to inpa9 tient hospital services furnished by such a 

10 hospital or critical access hospital to indi11 viduals who are entitled to benefits under 

12 part A of title XVIII of such Act or, as ap13 propriate, enrolled for benefits under part 

14 B of such title. 

15 (B) REPORT BY MEDPAC.—Not later than 

16 the first June 30th following the date on which 

17 the report is required under subparagraph (A), 

18 the Medicare Payment Advisory Commission 

19 shall submit to Congress a report, including 

20 recommendations and a technical prototype, on 

21 a post-acute care prospective payment system 

22 under title XVIII of the Social Security Act 

23 that would satisfy the criteria described in sub24 paragraph (A). 
31 

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1 (3) MEDICARE BENEFICIARY DEFINED.—For 

2 purposes of this subsection, the term ‘‘Medicare ben3 eficiary’’ has the meaning given such term in section 

4 1899B(a)(2) of the Social Security Act, as added by 

5 subsection (a). 

6 (c) PAYMENT CONSEQUENCES UNDER THE APPLICA7 BLE REPORTING PROVISIONS.— 

8 (1) HOME HEALTH AGENCIES.—Section 

9 1895(b)(3)(B)(v) of the Social Security Act (42 

10 U.S.C. 1395fff(b)(3)(B)(v)) is amended— 

11 (A) in subclause (I), by striking ‘‘subclause 

12 (II)’’ and inserting ‘‘subclauses (II) and (IV)’’; 

13 (B) in subclause (II), by striking ‘‘For 

14 2007’’ and inserting ‘‘Subject to subclause (V), 

15 for 2007’’; 

16 (C) in subclause (III), by inserting ‘‘and 

17 subclause (IV)(aa)’’ after ‘‘subclause (II)’’; and 

18 (D) by adding at the end the following new 

19 subclauses: 

20 ‘‘(IV) SUBMISSION OF ADDI21 TIONAL DATA.— 

22 ‘‘(aa) IN GENERAL.—For 

23 the year beginning on the speci24 fied application date (as defined 

25 in subsection (a)(2)(E) of section 
32 

•HR 4994 EH

1 1899B), as applicable with re2 spect to home health agencies 

3 and quality measures under sub4 section (c)(1) of such section and 

5 measures under subsection (d)(1) 

6 of such section, and each subse7 quent year, in addition to the 

8 data described in subclause (II), 

9 each home health agency shall 

10 submit to the Secretary data on 

11 such quality measures and any 

12 necessary data specified by the 

13 Secretary under such subsection 

14 (d)(1). 

15 ‘‘(bb) STANDARDIZED PA16 TIENT ASSESSMENT DATA.—For 

17 2019 and each subsequent year, 

18 in addition to such data de19 scribed in item (aa), each home 

20 health agency shall submit to the 

21 Secretary standardized patient 

22 assessment data required under 

23 subsection (b)(1) of section 

24 1899B. 
33 

•HR 4994 EH

1 ‘‘(cc) SUBMISSION.—Data 

2 shall be submitted under items 

3 (aa) and (bb) in the form and 

4 manner, and at the time, speci5 fied by the Secretary for pur6 poses of this clause. 

7 ‘‘(V) NON-DUPLICATION.—To the 

8 extent data submitted under subclause 

9 (IV) duplicates other data required to 

10 be submitted under subclause (II), the 

11 submission of such data under sub12 clause (IV) shall be in lieu of the sub13 mission of such data under subclause 

14 (II). The previous sentence shall not 

15 apply insofar as the Secretary deter16 mines it is necessary to avoid a delay 

17 in the implementation of section 

18 1899B, taking into account the dif19 ferent specified application dates 

20 under subsection (a)(2)(E) of such 

21 section.’’. 

22 (2) INPATIENT REHABILITATION FACILITIES.— 

23 Section 1886(j)(7) of the Social Security Act (42 

24 U.S.C. 1395ww(j)(7)) is amended— 
34 

•HR 4994 EH

1 (A) in subparagraph (A)(i), by striking 

2 ‘‘subparagraph (C)’’ and inserting ‘‘subpara3 graphs (C) and (F)’’; 

4 (B) in subparagraph (C), by striking ‘‘For 

5 fiscal year 2014 and each subsequent rate 

6 year’’ and inserting ‘‘Subject to subparagraph 

7 (G), for fiscal year 2014 and each subsequent 

8 fiscal year’’; 

9 (C) in subparagraph (E), by inserting 

10 ‘‘and subparagraph (F)(i)’’ after ‘‘subpara11 graph (C)’’; and 

12 (D) by adding at the end the following new 

13 subparagraphs: 

14 ‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 

15 ‘‘(i) IN GENERAL.—For the fiscal year 

16 beginning on the specified application date 

17 (as defined in subsection (a)(2)(E) of sec18 tion 1899B), as applicable with respect to 

19 inpatient rehabilitation facilities and qual20 ity measures under subsection (c)(1) of 

21 such section and measures under sub22 section (d)(1) of such section, and each 

23 subsequent fiscal year, in addition to such 

24 data on the quality measures described in 

25 subparagraph (C), each rehabilitation facil-
35 

•HR 4994 EH

1 ity shall submit to the Secretary data on 

2 the quality measures under such subsection 

3 (c)(1) and any necessary data specified by 

4 the Secretary under such subsection (d)(1). 

5 ‘‘(ii) STANDARDIZED PATIENT AS6 SESSMENT DATA.—For fiscal year 2019 

7 and each subsequent fiscal year, in addi8 tion to such data described in clause (i), 

9 each rehabilitation facility shall submit to 

10 the Secretary standardized patient assess11 ment data required under subsection (b)(1) 

12 of section 1899B. 

13 ‘‘(iii) SUBMISSION.—Such data shall 

14 be submitted in the form and manner, and 

15 at the time, specified by the Secretary for 

16 purposes of this subparagraph. 

17 ‘‘(G) NON-DUPLICATION.—To the extent 

18 data submitted under subparagraph (F) dupli19 cates other data required to be submitted under 

20 subparagraph (C), the submission of such data 

21 under subparagraph (F) shall be in lieu of the 

22 submission of such data under subparagraph 

23 (C). The previous sentence shall not apply inso24 far as the Secretary determines it is necessary 

25 to avoid a delay in the implementation of sec-
36 

•HR 4994 EH

1 tion 1899B, taking into account the different 

2 specified application dates under subsection 

3 (a)(2)(E) of such section.’’. 

4 (3) LONG-TERM CARE HOSPITALS.—Section 

5 1886(m)(5) of the Social Security Act (42 U.S.C. 

6 1395ww(m)(5)) is amended— 

7 (A) in subparagraph (A)(i), by striking 

8 ‘‘subparagraph (C)’’ and inserting ‘‘subpara9 graphs (C) and (F)’’; 

10 (B) in subparagraph (C), by striking ‘‘For 

11 rate year’’ and inserting ‘‘Subject to subpara12 graph (G), for rate year’’; 

13 (C) in subparagraph (E), by inserting 

14 ‘‘and subparagraph (F)(i)’’ after ‘‘subpara15 graph (C)’’; and 

16 (D) by adding at the end the following new 

17 subparagraphs: 

18 ‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 

19 ‘‘(i) IN GENERAL.—For the rate year 

20 beginning on the specified application date 

21 (as defined in subsection (a)(2)(E) of sec22 tion 1899B), as applicable with respect to 

23 long-term care hospitals and quality meas24 ures under subsection (c)(1) of such sec25 tion and measures under subsection (d)(1) 
37 

•HR 4994 EH

1 of such section, and each subsequent rate 

2 year, in addition to the data on the quality 

3 measures described in subparagraph (C), 

4 each long-term care hospital (other than a 

5 hospital classified under subsection 

6 (d)(1)(B)(iv)(II)) shall submit to the Sec7 retary data on the quality measures under 

8 such subsection (c)(1) and any necessary 

9 data specified by the Secretary under such 

10 subsection (d)(1). 

11 ‘‘(ii) STANDARDIZED PATIENT AS12 SESSMENT DATA.—For rate year 2019 and 

13 each subsequent rate year, in addition to 

14 such data described in clause (i), each 

15 long-term care hospital (other than a hos16 pital classified under subsection 

17 (d)(1)(B)(iv)(II)) shall submit to the Sec18 retary standardized patient assessment 

19 data required under subsection (b)(1) of 

20 section 1899B. 

21 ‘‘(iii) SUBMISSION.—Such data shall 

22 be submitted in the form and manner, and 

23 at the time, specified by the Secretary for 

24 purposes of this subparagraph. 
38 

•HR 4994 EH

1 ‘‘(G) NON-DUPLICATION.—To the extent 

2 data submitted under subparagraph (F) dupli3 cates other data required to be submitted under 

4 subparagraph (C), the submission of such data 

5 under subparagraph (F) shall be in lieu of the 

6 submission of such data under subparagraph 

7 (C). The previous sentence shall not apply inso8 far as the Secretary determines it is necessary 

9 to avoid a delay in the implementation of sec10 tion 1899B, taking into account the different 

11 specified application dates under subsection 

12 (a)(2)(E) of such section.’’. 

13 (4) SKILLED NURSING FACILITIES.— 

14 (A) IN GENERAL.—Paragraph (6) of sec15 tion 1888(e) of the Social Security Act (42 

16 U.S.C. 1395yy(e)) is amended to read as fol17 lows: 

18 ‘‘(6) REPORTING OF ASSESSMENT AND QUALITY

19 DATA.— 

20 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

21 TO REPORT.— 

22 ‘‘(i) IN GENERAL.—For fiscal years 

23 beginning with fiscal year 2018, in the 

24 case of a skilled nursing facility that does 

25 not submit data, as applicable, in accord-
39 

•HR 4994 EH

1 ance with subclauses (II) and (III) of sub2 paragraph (B)(i) with respect to such a 

3 fiscal year, after determining the percent4 age described in paragraph (5)(B)(i), and 

5 after application of paragraph (5)(B)(ii), 

6 the Secretary shall reduce such percentage 

7 for payment rates during such fiscal year 

8 by 2 percentage points. 

9 ‘‘(ii) SPECIAL RULE.—The application 

10 of this subparagraph may result in the per11 centage described in paragraph (5)(B)(i), 

12 after application of paragraph (5)(B)(ii), 

13 being less than 0.0 for a fiscal year, and 

14 may result in payment rates under this 

15 subsection for a fiscal year being less than 

16 such payment rates for the preceding fiscal 

17 year. 

18 ‘‘(iii) NONCUMULATIVE APPLICA19 TION.—Any reduction under clause (i) 

20 shall apply only with respect to the fiscal 

21 year involved and the Secretary shall not 

22 take into account such reduction in com23 puting the payment amount under this 

24 subsection for a subsequent fiscal year. 

25 ‘‘(B) ASSESSMENT AND MEASURE DATA.— 
40 

•HR 4994 EH

1 ‘‘(i) IN GENERAL.—A skilled nursing 

2 facility, or a facility (other than a critical 

3 access hospital) described in paragraph 

4 (7)(B), shall submit to the Secretary, in a 

5 manner and within the timeframes pre6 scribed by the Secretary— 

7 ‘‘(I) subject to clause (iii), the 

8 resident assessment data necessary to 

9 develop and implement the rates 

10 under this subsection; 

11 ‘‘(II) for fiscal years beginning 

12 on or after the specified application 

13 date (as defined in subsection 

14 (a)(2)(E) of section 1899B), as appli15 cable with respect to skilled nursing 

16 facilities and quality measures under 

17 subsection (c)(1) of such section and 

18 measures under subsection (d)(1) of 

19 such section, data on such quality 

20 measures under such subsection (c)(1) 

21 and any necessary data specified by 

22 the Secretary under such subsection 

23 (d)(1); and 

24 ‘‘(III) for fiscal years beginning 

25 on or after October 1, 2018, stand-
41 

•HR 4994 EH

1 ardized patient assessment data re2 quired under subsection (b)(1) of sec3 tion 1899B. 

4 ‘‘(ii) USE OF STANDARD INSTRU5 MENT.—For purposes of meeting the re6 quirement under clause (i), a skilled nurs7 ing facility, or a facility (other than a crit8 ical access hospital) described in paragraph 

9 (7)(B), may submit the resident assess10 ment data required under section 

11 1819(b)(3), using the standard instrument 

12 designated by the State under section 

13 1819(e)(5). 

14 ‘‘(iii) NON-DUPLICATION.—To the ex15 tent data submitted under subclause (II) 

16 or (III) of clause (i) duplicates other data 

17 required to be submitted under clause 

18 (i)(I), the submission of such data under 

19 such a subclause shall be in lieu of the 

20 submission of such data under clause 

21 (i)(I). The previous sentence shall not 

22 apply insofar as the Secretary determines 

23 it is necessary to avoid a delay in the im24 plementation of section 1899B, taking into 

25 account the different specified application 
42 

•HR 4994 EH

1 dates under subsection (a)(2)(E) of such 

2 section.’’. 

3 (B) FUNDING FOR NURSING HOME COM4 PARE WEBSITE.—Section 1819(i) of the Social 

5 Security Act (42 U.S.C. 1395i–3(i)) is amended 

6 by adding at the end the following new para7 graph: 

8 ‘‘(3) FUNDING.—The Secretary shall transfer 

9 to the Centers for Medicare & Medicaid Services 

10 Program Management Account, from the Federal 

11 Hospital Insurance Trust Fund under section 1817 

12 a one-time allocation of $11,000,000. The amount 

13 shall be available on the date of the enactment of 

14 this paragraph. Such sums shall remain available 

15 until expended. Such sums shall be used to imple16 ment section 1128I(g).’’. 

17 (d) IMPROVING PAYMENT ACCURACY UNDER THE

18 PAC PAYMENT SYSTEMS AND OTHER MEDICARE PAY19 MENT SYSTEMS.— 

20 (1) STUDIES AND REPORTS OF EFFECT OF CER21 TAIN INFORMATION ON QUALITY AND RESOURCE

22 USE.— 

23 (A) STUDY USING EXISTING MEDICARE

24 DATA.— 
43 

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1 (i) STUDY.—The Secretary of Health 

2 and Human Services (in this subsection re3 ferred to as the ‘‘Secretary’’) shall conduct 

4 a study that examines the effect of individ5 uals’ socioeconomic status on quality meas6 ures and resource use and other measures 

7 for individuals under the Medicare pro8 gram under title XVIII of the Social Secu9 rity Act (42 U.S.C. 1395 et seq.) (such as 

10 to recognize that less healthy individuals 

11 may require more intensive interventions). 

12 The study shall use information collected 

13 on such individuals in carrying out such 

14 program, such as urban and rural location, 

15 eligibility for Medicaid under title XIX of 

16 such Act (42 U.S.C. 1396 et seq.) (recog17 nizing and accounting for varying Medicaid 

18 eligibility across States), and eligibility for 

19 benefits under the supplemental security 

20 income (SSI) program. The Secretary shall 

21 carry out this paragraph acting through 

22 the Assistant Secretary for Planning and 

23 Evaluation. 

24 (ii) REPORT.—Not later than 2 years 

25 after the date of the enactment of this Act, 
44 

•HR 4994 EH

1 the Secretary shall submit to Congress a 

2 report on the study conducted under clause 

3 (i). 

4 (B) STUDY USING OTHER DATA.— 

5 (i) STUDY.—The Secretary shall con6 duct a study that examines the impact of 

7 risk factors, such as those described in sec8 tion 1848(p)(3) of the Social Security Act 

9 (42 U.S.C. 1395w–4(p)(3)), race, health 

10 literacy, limited English proficiency (LEP), 

11 and Medicare beneficiary activation, on 

12 quality measures and resource use and 

13 other measures under the Medicare pro14 gram (such as to recognize that less 

15 healthy individuals may require more in16 tensive interventions). In conducting such 

17 study the Secretary may use existing Fed18 eral data and collect such additional data 

19 as may be necessary to complete the study. 

20 (ii) REPORT.—Not later than 5 years 

21 after the date of the enactment of this Act, 

22 the Secretary shall submit to Congress a 

23 report on the study conducted under clause 

24 (i). 
45 

•HR 4994 EH

1 (C) EXAMINATION OF DATA IN CON2 DUCTING STUDIES.—In conducting the studies 

3 under subparagraphs (A) and (B), the Sec4 retary shall examine what non-Medicare data 

5 sets, such as data from the American Commu6 nity Survey (ACS), can be useful in conducting 

7 the types of studies under such paragraphs and 

8 how such data sets that are identified as useful 

9 can be coordinated with Medicare administra10 tive data in order to improve the overall data 

11 set available to do such studies and for the ad12 ministration of the Medicare program. 

13 (D) RECOMMENDATIONS TO ACCOUNT FOR

14 INFORMATION IN PAYMENT ADJUSTMENT

15 MECHANISMS.—If the studies conducted under 

16 subparagraphs (A) and (B) find a relationship 

17 between the factors examined in the studies and 

18 quality measures and resource use and other 

19 measures, then the Secretary shall also provide 

20 recommendations for how the Centers for Medi21 care & Medicaid Services should— 

22 (i) obtain access to the necessary data 

23 (if such data is not already being collected) 

24 on such factors, including recommenda-
46 

•HR 4994 EH

1 tions on how to address barriers to the 

2 Centers in accessing such data; and 

3 (ii) account for such factors— 

4 (I) in quality measures, resource 

5 use measures, and other measures 

6 under title XVIII of the Social Secu7 rity Act (including such measures 

8 specified under subsections (c) and 

9 (d) of section 1899B of such Act, as 

10 added by subsection (a)); and 

11 (II) in determining payment ad12 justments based on such measures in 

13 other applicable provisions of such 

14 title. 

15 (E) FUNDING.—There are hereby appro16 priated to the Secretary from the Federal Hos17 pital Insurance Trust Fund under section 1817 

18 of the Social Security Act (42 U.S.C. 1395i) 

19 and the Federal Supplementary Medical Insur20 ance Trust Fund under section 1841 of such 

21 Act (42 U.S.C. 1395t) (in proportions deter22 mined appropriate by the Secretary) to carry 

23 out this paragraph $6,000,000, to remain avail24 able until expended. 

25 (2) CMS ACTIVITIES.— 
47 

•HR 4994 EH

1 (A) IN GENERAL.—Taking into account 

2 the relevant studies conducted and rec3 ommendations made in reports under para4 graph (1) and, as appropriate, other informa5 tion, including information collected before com6 pletion of such studies and recommendations, 

7 the Secretary, on an ongoing basis, shall, as the 

8 Secretary determines appropriate and based on 

9 an individual’s health status and other fac10 tors— 

11 (i) assess appropriate adjustments to 

12 quality measures, resource use measures, 

13 and other measures under title XVIII of 

14 the Social Security Act (42 U.S.C. 1395 et 

15 seq.) (including measures specified in sub16 sections (c) and (d) of section 1899B of 

17 such Act, as added by subsection (a)); and 

18 (ii) assess and implement appropriate 

19 adjustments to payments under such title 

20 based on measures described in clause (i). 

21 (B) ACCESSING DATA.—The Secretary 

22 shall collect or otherwise obtain access to the 

23 data necessary to carry out this paragraph 

24 through existing and new data sources. 
48 

•HR 4994 EH

1 (C) PERIODIC ANALYSES.—The Secretary 

2 shall carry out periodic analyses, at least every 

3 3 years, based on the factors referred to in sub4 paragraph (A) so as to monitor changes in pos5 sible relationships. 

6 (D) FUNDING.—There are hereby appro7 priated to the Secretary from the Federal Hos8 pital Insurance Trust Fund under section 1817 

9 of the Social Security Act (42 U.S.C. 1395i) 

10 and the Federal Supplementary Medical Insur11 ance Trust Fund under section 1841 of such 

12 Act (42 U.S.C. 1395t) (in proportions deter13 mined appropriate by the Secretary) to carry 

14 out this paragraph $10,000,000, to remain 

15 available until expended. 

16 (3) STRATEGIC PLAN FOR ACCESSING RACE

17 AND ETHNICITY DATA.—Not later than 18 months 

18 after the date of the enactment of this Act, the Sec19 retary shall develop and report to Congress on a 

20 strategic plan for collecting or otherwise accessing 

21 data on race and ethnicity for purposes of specifying 

22 quality measures and resource use and other meas23 ures under subsections (c) and (d) of section 1899B 

24 of the Social Security Act, as added by subsection 

25 (a), and, as the Secretary determines appropriate, 
49 

•HR 4994 EH

1 other similar provisions of, including payment ad2 justments under, title XVIII of such Act (42 U.S.C. 

3 1395 et seq.). 

4 SEC. 3. HOSPICE CARE. 

5 (a) HOSPICE SURVEY REQUIREMENT.— 

6 (1) IN GENERAL.—Section 1861(dd)(4) of the 

7 Social Security Act (42 U.S.C. 1395x(dd)(4)) is 

8 amended by adding at the end the following new 

9 subparagraph: 

10 ‘‘(C) Any entity that is certified as a hospice program 

11 shall be subject to a standard survey by an appropriate 

12 State or local survey agency, or an approved accreditation 

13 agency, as determined by the Secretary, not less fre14 quently than once every 36 months beginning 6 months 

15 after the date of the enactment of this subparagraph and 

16 ending September 30, 2025.’’. 

17 (2) FUNDING.—For purposes of carrying out 

18 subparagraph (C) of section 1861(dd)(4) of the So19 cial Security Act (42 U.S.C. 1395x(dd)(4)), as 

20 added by paragraph (1), there shall be transferred 

21 from the Federal Hospital Insurance Trust Fund 

22 under section 1817 of such Act (42 U.S.C. 1395i) 

23 to the Centers for Medicare & Medicaid Services 

24 Program Management Account— 
50 

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1 (A) $25,000,000 for fiscal years 2015 

2 through 2017, to be made available for such 

3 purposes in equal parts for each such fiscal 

4 year; and 

5 (B) $45,000,000 for fiscal years 2018 

6 through 2025, to be made available for such 

7 purposes in equal parts for each such fiscal 

8 year. 

9 (b) HOSPICE PROGRAM ELIGIBILITY RECERTIFI10 CATION TECHNICAL CORRECTION TO APPLY LIMITATION

11 ON LIABILITY OF BENEFICIARY RULES.—Section 1879 of 

12 the Social Security Act (42 U.S.C. 1395pp) is amended 

13 by adding at the end the following new subsection: 

14 ‘‘(i) The provisions of this section shall apply with 

15 respect to a denial of a payment under this title by reason 

16 of section 1814(a)(7)(E) in the same manner as such pro17 visions apply with respect to a denial of a payment under 

18 this title by reason of section 1862(a)(1).’’. 

19 (c) REVISION TO REQUIREMENT FOR MEDICAL RE20 VIEW OF CERTAIN HOSPICE CARE.—Section 1814(a)(7) 

21 of the Social Security Act (42 U.S.C. 1395f(a)(7)) is 

22 amended— 

23 (1) in subparagraph (C), by striking ‘‘and’’ at 

24 the end; 
51 

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1 (2) in subparagraph (D), in the matter pre2 ceding clause (i), by inserting ‘‘(and, in the case of 

3 clause (ii), before the date of enactment of subpara4 graph (E))’’ after ‘‘2011’’; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(E) on and after the date of enactment of 

8 this subparagraph, in the case of hospice care 

9 provided an individual for more than 180 days 

10 by a hospice program for which the number of 

11 such cases for such program comprises more 

12 than a percent (specified by the Secretary) of 

13 the total number of all cases of individuals pro14 vided hospice care by the program under this 

15 title, the hospice care provided to such indi16 vidual is medically reviewed (in accordance with 

17 procedures established by the Secretary); and’’. 

18 (d) UPDATE OF HOSPICE AGGREGATE PAYMENT

19 CAP.—Section 1814(i)(2)(B) of the Social Security Act 

20 (42 U.S.C. 1395f(i)(2)(B)) is amended— 

21 (1) by striking ‘‘(B) For purposes’’ and insert22 ing ‘‘(B)(i) Except as provided in clause (ii), for 

23 purposes’’; and 

24 (2) by adding at the end the following: 
52 

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1 ‘‘(ii) For purposes of subparagraph (A) for account2 ing years that end after September 30, 2016, and before 

3 October 1, 2025, the ‘cap amount’ is the cap amount 

4 under this subparagraph for the preceding accounting 

5 year updated by the percentage update to payment rates 

6 for hospice care under paragraph (1)(C) for services fur7 nished during the fiscal year beginning on the October 1 

8 preceding the beginning of the accounting year (including 

9 the application of any productivity or other adjustment 

10 under clause (iv) of that paragraph). 

11 ‘‘(iii) For accounting years that end after September 

12 30, 2025, the cap amount shall be computed under clause 

13 (i) as if clause (ii) had never applied.’’. 

14 (e) MEDICARE IMPROVEMENT FUND.—Section 1898 

15 of the Social Security Act (42 U.S.C. 1395iii) is amend16 ed— 

17 (1) by amending the heading to read as follows: 

18 ‘‘MEDICARE IMPROVEMENT FUND’’; 

19 (2) by amending subsection (a) to read as fol20 lows: 

21 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab22 lish under this title a Medicare Improvement Fund (in this 

23 section referred to as the ‘Fund’) which shall be available 

24 to the Secretary to make improvements under the original 

25 Medicare fee-for-service program under parts A and B for 
53 

•HR 4994 EH

1 individuals entitled to, or enrolled for, benefits under part 

2 or enrolled under part B including adjustments to pay3 ments for items and services furnished by providers of 

4 services and suppliers under such original Medicare fee5 for-service program.’’; 

6 (3) in subsection (b)(1), by striking ‘‘during’’ 

7 and all that follows and inserting ‘‘during and after 

8 fiscal year 2020, $195,000,000.’’; and 

9 (4) in subsection (b)(2), by striking ‘‘from the 

10 Federal’’ and all that follows and inserting ‘‘from 

11 the Federal Hospital Insurance Trust Fund and the 

12 Federal Supplementary Medical Insurance Trust 

13 Fund in such proportion as the Secretary determines 

14 appropriate.’’. 

Passed the House of Representatives September 16, 

2014. 

Attest: 

Clerk. 
113TH CONGRESS 

2D SESSION H. R. 4994 

AN ACT 

To amend title XVIII of the Social Security Act to 

planning, and for other purposes. ment data for quality, payment, and discharge provide for standardized post-acute care assess-