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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2553 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2553

    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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 26, 2014

 Mr. Wyden (for himself and Mr. Hatch) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
    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 such 
                        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, 
                        self care, and history of major falls--
                                    ``(I) in the period immediately 
                                prior to the reason for acute 
                                hospitalization; or
                                    ``(II) in the case of no antecedent 
                                acute hospitalization, in the period 
                                prior to the use of post-acute care 
                                services.
                            ``(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 elements.--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.--
                    ``(A) Length of episode.--With respect to the 
                length of an episode, the Secretary shall, to the 
                extent the Secretary determines appropriate, align 
                resource use and other measures specified under this 
                subsection with respect to the domain described in 
                paragraph (1)(A) 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 before one year after 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, including through a process consistent 
        with the process applied under section 1886(b)(3)(B)(viii)(VII) 
        for similar purposes, 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 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 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, 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 Medicare Beneficiary 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 such PAC providers, patients, and families of such 
        patients with discharge planning from inpatient settings, 
        including subsection (d) hospitals, critical access hospitals, 
        and hospitals described in section 1886(d)(1)(B)(v), 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 payments 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 payments 
                                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 (IV)(cc), 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 
                subclause:
                                    ``(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, 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) Non-duplication.--To 
                                        the extent such standardized 
                                        data under subsection (b)(1) of 
                                        such section 1899B, data on 
                                        quality measures required under 
                                        subsection (c)(1) of such 
                                        section, or necessary data 
                                        required under subsection 
                                        (d)(1) of such section are 
                                        duplicative of any other data 
                                        required to be reported under 
                                        this subclause, the submission 
                                        of such standardized data, data 
                                        on such quality measures, or 
                                        necessary data, respectively, 
                                        shall be required under this 
                                        subclause in lieu of the 
                                        submission of such other data.
                                            ``(dd) Submission.--Such 
                                        data shall be submitted in the 
                                        form and manner, and at the 
                                        time, specified by the 
                                        Secretary for purposes of 
                                        subclause (II).''.
            (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'' and inserting ``Subject to subparagraph 
                (F)(iii), for 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 
                subparagraph:
                    ``(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) Non-duplication.--To the extent 
                        such standardized data under subsection (b)(1) 
                        of such section 1899B, data on quality measures 
                        required under subsection (c)(1) of such 
                        section, or necessary data required under 
                        subsection (d)(1) of such section are 
                        duplicative of any other data required to be 
                        reported under this subparagraph, the 
                        submission of such standardized data, data on 
                        such quality measures, or necessary data, 
                        respectively, shall be required under this 
                        subparagraph in lieu of the submission of such 
                        other data.
                            ``(iv) Submission.--Such data shall be 
                        submitted in the form and manner, and at the 
                        time, specified by the Secretary for purposes 
                        of subparagraph (C).''.
            (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 
                (F)(iii), 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 
                subparagraph:
                    ``(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 (b)(3)(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 (b)(3)(B)(iv)(II)) shall submit to 
                        the Secretary standardized patient assessment 
                        data required under subsection (b)(1) of 
                        section 1899B.
                            ``(iii) Non-duplication.--To the extent 
                        such standardized data under subsection (b)(1) 
                        of such section 1899B, data on quality measures 
                        required under subsection (c)(1) of such 
                        section, or necessary data required under 
                        subsection (d)(1) of such section are 
                        duplicative of any other data required to be 
                        reported under this subparagraph, the 
                        submission of such standardized data, data on 
                        such quality measures, or necessary data, 
                        respectively, shall be required under this 
                        subparagraph in lieu of the submission of such 
                        other data.
                            ``(iv) Submission.--Such data shall be 
                        submitted in the form and manner, and at the 
                        time, specified by the Secretary for purposes 
                        of subparagraph (C).''.
            (4) Skilled nursing facilities.--
                    (A) In general.--Paragraph (6) of section 1888(e) 
                of the Social Security Act 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 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, in the case of a skilled nursing 
                        facility that does not submit, in accordance 
                        with subparagraph (B) with respect to such a 
                        fiscal year, data on the quality measures 
                        specified under such subsection (c)(1), any 
                        necessary data specified by the Secretary under 
                        such subsection (d)(1), and (for fiscal years 
                        beginning on or after October 1, 2018) 
                        standardized patient assessment data specified 
                        under subsection (b)(1) of such section, 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 described in paragraph 
                        (7)(B), shall submit to the Secretary, in a 
                        manner and within the timeframes prescribed by 
                        the Secretary--
                                    ``(I) 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.
                        To the extent such standardized data under 
                        subsection (b)(1) of such section, data on 
                        quality measures required under subsection 
                        (c)(1) of such section, or necessary data 
                        required under subsection (d)(1) of such 
                        section are duplicative of any other data 
                        required to be reported under this 
                        subparagraph, the submission of such 
                        standardized data, data on such quality 
                        measures, or necessary data, respectively, 
                        shall be required under this subparagraph in 
                        lieu of the submission of such other data.
                            ``(ii) Use of standard instrument.--For 
                        purposes of meeting the requirement under 
                        clause (i), a skilled nursing facility, or a 
                        facility 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).''.
                    (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 
                                subsections (c) and (d) of section 
                                1899B of the Social Security Act, as 
                                added by subsection (a), and under 
                                other applicable provisions of title 
                                XVIII of such Act (42 U.S.C. 1395 et 
                                seq.); 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.
                    (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 provision of, including payment adjustments 
        under, title XVIII of such Act (42 U.S.C. 1395 et seq.).
                                 <all>
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