II 

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. 

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

3 SECTION 1. SHORT TITLE. 

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

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

6 ‘‘IMPACT Act of 2014’’. 


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

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

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

4 section: 

5 ‘‘SEC. 1899B. STANDARDIZED POST-ACUTE CARE (PAC) AS6 SESSMENT DATA FOR QUALITY, PAYMENT, 

7 AND DISCHARGE PLANNING. 

8 ‘‘(a) REQUIREMENT FOR STANDARDIZED ASSESS9 MENT DATA.— 

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

11 ‘‘(A) require under the applicable reporting 

12 provisions post-acute care providers (as defined 

13 in paragraph (2)(A)) to report— 

14 ‘‘(i) standardized patient assessment 

15 data in accordance with subsection (b); 

16 ‘‘(ii) data on quality measures under 

17 subsection (c)(1); and 

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

19 measures under subsection (d)(1); 

20 ‘‘(B) require data described in subpara21 graph (A) to be standardized and interoperable 

22 so as to allow for the exchange of such data 

23 among such post-acute care providers and other 

24 providers and the use by such providers of such 

25 data that has been so exchanged, including by 

26 using common standards and definitions, in 


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1 order to provide access to longitudinal informa2 tion for such providers to facilitate coordinated 

3 care and improved Medicare beneficiary out4 comes; and 

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

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

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

8 post-acute care providers to— 

9 ‘‘(i) provide for the submission of 

10 standardized patient assessment data 

11 under this title with respect to such pro12 viders; and 

13 ‘‘(ii) enable comparison of such as14 sessment data across all such providers to 

15 whom such data are applicable. 

16 ‘‘(2) DEFINITIONS.—For purposes of this sec17 tion: 

18 ‘‘(A) POST-ACUTE CARE (PAC) PRO19 VIDER.—The terms ‘post-acute care provider’ 

20 and ‘PAC provider’ mean— 

21 ‘‘(i) a home health agency; 

22 ‘‘(ii) a skilled nursing facility; 

23 ‘‘(iii) an inpatient rehabilitation facil24 ity; and 


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

2 than a hospital classified under section 

3 1886(d)(1)(B)(iv)(II)). 

4 ‘‘(B) PAC ASSESSMENT INSTRUMENT.— 

5 The term ‘PAC assessment instrument’ 

6 means— 

7 ‘‘(i) in the case of home health agen8 cies, the instrument used for purposes of 

9 reporting and assessment with respect to 

10 the Outcome and Assessment Information 

11 Set (OASIS), as described in sections 

12 484.55 and 484.250 of title 42, the Code 

13 of Federal Regulations, or any successor 

14 regulation, or any other instrument used 

15 with respect to home health agencies for 

16 such purposes; 

17 ‘‘(ii) in the case of skilled nursing fa18 cilities, the resident’s assessment under 

19 section 1819(b)(3); 

20 ‘‘(iii) in the case of inpatient rehabili21 tation facilities, any Medicare beneficiary 

22 assessment instrument established by the 

23 Secretary for purposes of section 1886(j); 

24 and 


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

2 hospitals, the Medicare beneficiary assess3 ment instrument used with respect to such 

4 hospitals for the collection of data elements 

5 necessary to calculate quality measures as 

6 described in the August 18, 2011, Federal 

7 Register (76 Fed. Reg. 51754–51755), in8 cluding for purposes of section 

9 1886(m)(5)(C), or any other instrument 

10 used with respect to such hospitals for 

11 such purposes. 

12 ‘‘(C) APPLICABLE REPORTING PROVI13 SION.—The term ‘applicable reporting provi14 sion’ means— 

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

16 1895(b)(3)(B)(v); 

17 ‘‘(ii) for skilled nursing facilities, sec18 tion 1888(e)(6); 

19 ‘‘(iii) for inpatient rehabilitation facili20 ties, section 1886(j)(7); and 

21 ‘‘(iv) for long-term care hospitals, sec22 tion 1886(m)(5). 

23 ‘‘(D) PAC PAYMENT SYSTEM.—The term 

24 ‘PAC payment system’ means— 


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

2 agency, the prospective payment system 

3 under section 1895; 

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

5 facility, the prospective payment system 

6 under section 1888(e); 

7 ‘‘(iii) with respect to an inpatient re8 habilitation facility, the prospective pay9 ment system under section 1886(j); and 

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

11 hospital, the prospective payment system 

12 under section 1886(m). 

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

14 term ‘specified application date’ means the fol15 lowing: 

16 ‘‘(i) QUALITY MEASURES.—In the 

17 case of quality measures under subsection 

18 (c)(1)— 

19 ‘‘(I) with respect to the domain 

20 described in subsection (c)(1)(A) (re21 lating to functional status, cognitive 

22 function, and changes in function and 

23 cognitive function)— 

24 ‘‘(aa) for PAC providers de25 scribed in clauses (ii) and (iii) of 


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

2 2016; 

3 ‘‘(bb) for PAC providers de4 scribed in clause (iv) of such 

5 paragraph, October 1, 2018; and 

6 ‘‘(cc) for PAC providers de7 scribed in clause (i) of such para8 graph, January 1, 2019; 

9 ‘‘(II) with respect to the domain 

10 described in subsection (c)(1)(B) (re11 lating to skin integrity and changes in 

12 skin integrity)— 

13 ‘‘(aa) for PAC providers de14 scribed in clauses (ii), (iii), and 

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

16 1, 2016; and 

17 ‘‘(bb) for PAC providers de18 scribed in clause (i) of such para19 graph, January 1, 2017; 

20 ‘‘(III) with respect to the domain 

21 described in subsection (c)(1)(C) (re22 lating to medication reconciliation)— 

23 ‘‘(aa) for PAC providers de24 scribed in clause (i) of such para25 graph, January 1, 2017; and 


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1 ‘‘(bb) for PAC providers de2 scribed in clauses (ii), (iii), and 

3 (iv) of such paragraph, October 

4 1, 2018; 

5 ‘‘(IV) with respect to the domain 

6 described in subsection (c)(1)(D) (re7 lating to incidence of major falls)— 

8 ‘‘(aa) for PAC providers de9 scribed in clauses (ii), (iii), and 

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

11 1, 2016; and 

12 ‘‘(bb) for PAC providers de13 scribed in clause (i) of such para14 graph, January 1, 2019; and 

15 ‘‘(V) with respect to the domain 

16 described in subsection (c)(1)(E) (re17 lating to accurately communicating 

18 the existence of and providing for the 

19 transfer of health information and 

20 care preferences)— 

21 ‘‘(aa) for PAC providers de22 scribed in clauses (ii), (iii), and 

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

24 1, 2018; and 


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1 ‘‘(bb) for PAC providers de2 scribed in clause (i) of such para3 graph, January 1, 2019. 

4 ‘‘(ii) RESOURCE USE AND OTHER

5 MEASURES.—In the case of resource use 

6 and other measures under subsection 

7 (d)(1)— 

8 ‘‘(I) for PAC providers described 

9 in clauses (ii), (iii), and (iv) of para10 graph (2)(A), October 1, 2016; and 

11 ‘‘(II) for PAC providers de12 scribed in clause (i) of such para13 graph, January 1, 2017. 

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

15 ‘Medicare beneficiary’ means an individual enti16 tled to benefits under part A or, as appropriate, 

17 enrolled for benefits under part B. 

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

19 ‘‘(1) REQUIREMENT FOR REPORTING ASSESS20 MENT DATA.— 

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

22 than October 1, 2018, for PAC providers de23 scribed in clauses (ii), (iii), and (iv) of sub24 section (a)(2)(A) and January 1, 2019, for 

25 PAC providers described in clause (i) of such 


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1 subsection, the Secretary shall require PAC 

2 providers to submit to the Secretary, under the 

3 applicable reporting provisions and through the 

4 use of PAC assessment instruments, the stand5 ardized patient assessment data described in 

6 subparagraph (B). The Secretary shall require 

7 such data be submitted with respect to admis8 sion and discharge of an individual (and may be 

9 submitted more frequently as the Secretary 

10 deems appropriate). 

11 ‘‘(B) STANDARDIZED PATIENT ASSESS12 MENT DATA DESCRIBED.—For purposes of sub13 paragraph (A), the standardized patient assess14 ment data described in this subparagraph is 

15 data required for at least the quality measures 

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

17 respect to the following categories: 

18 ‘‘(i) Functional status, such as mobil19 ity, self care, and history of major falls— 

20 ‘‘(I) in the period immediately 

21 prior to the reason for acute hos22 pitalization; or 

23 ‘‘(II) in the case of no antecedent 

24 acute hospitalization, in the period 


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1 prior to the use of post-acute care 

2 services. 

3 ‘‘(ii) Cognitive function, such as abil4 ity to express ideas and to understand, and 

5 mental status, such as depression and de6 mentia. 

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

8 interventions, such as need for ventilator 

9 use, dialysis, chemotherapy, central line 

10 placement, and total parenteral nutrition. 

11 ‘‘(iv) Medical conditions and co12 morbidities, such as diabetes, congestive 

13 heart failure, and pressure ulcers. 

14 ‘‘(v) Impairments, such as inconti15 nence and an impaired ability to hear, see, 

16 or swallow. 

17 ‘‘(vi) Other categories deemed nec18 essary and appropriate by the Secretary. 

19 ‘‘(2) ALIGNMENT OF CLAIMS DATA WITH

20 STANDARDIZED PATIENT ASSESSMENT DATA.—To 

21 the extent practicable, not later than October 1, 

22 2018, for PAC providers described in clauses (ii), 

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

24 1, 2019, for PAC providers described in clause (i) of 

25 such subsection, the Secretary shall match claims 


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1 data with assessment data pursuant to this section 

2 for purposes of assessing prior service use and con3 current service use, such as antecedent hospital or 

4 PAC provider use, and may use such matched data 

5 for such other uses as the Secretary determines ap6 propriate. 

7 ‘‘(3) REPLACEMENT OF CERTAIN EXISTING

8 DATA ELEMENTS.—In the case of patient assessment 

9 data being used with respect to a PAC assessment 

10 instrument that duplicates or overlaps with stand11 ardized patient assessment data within a category 

12 described in paragraph (1), the Secretary shall, as 

13 soon as practicable, revise or replace such existing 

14 data with the standardized data. 

15 ‘‘(4) CLARIFICATION.—Standardized patient as16 sessment data submitted pursuant to this subsection 

17 shall not be used to require individuals to be pro18 vided post-acute care by a specific type of PAC pro19 vider in order for such care to be eligible for pay20 ment under this title. 

21 ‘‘(c) QUALITY MEASURES.— 

22 ‘‘(1) REQUIREMENT FOR REPORTING QUALITY

23 MEASURES.—Not later than the specified application 

24 date, as applicable to measures and PAC providers, 

25 the Secretary shall specify quality measures on 


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1 which PAC providers are required under the applica2 ble reporting provisions to submit standardized pa3 tient assessment data described in subsection (b)(1) 

4 and other necessary data specified by the Secretary. 

5 Such measures shall be with respect to at least the 

6 following domains: 

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

8 and changes in function and cognitive function. 

9 ‘‘(B) Skin integrity and changes in skin in10 tegrity. 

11 ‘‘(C) Medication reconciliation. 

12 ‘‘(D) Incidence of major falls. 

13 ‘‘(E) Accurately communicating the exist14 ence of and providing for the transfer of health 

15 information and care preferences of an indi16 vidual to the individual, family caregiver of the 

17 individual, and providers of services furnishing 

18 items and services to the individual, when the 

19 individual transitions— 

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

21 hospital to another applicable setting, in22 cluding a PAC provider or the home of the 

23 individual; or 

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

25 applicable setting, including a different 


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1 PAC provider, a hospital, a critical access 

2 hospital, or the home of the individual. 

3 ‘‘(2) REPORTING THROUGH PAC ASSESSMENT

4 INSTRUMENTS.— 

5 ‘‘(A) IN GENERAL.—To the extent pos6 sible, the Secretary shall require such reporting 

7 by a PAC provider of quality measures under 

8 paragraph (1) through the use of a PAC assess9 ment instrument and shall modify such PAC 

10 assessment instrument as necessary to enable 

11 the use of such instrument with respect to such 

12 quality measures. 

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

14 not make significant modifications to a PAC as15 sessment instrument more than once per cal16 endar year or fiscal year, as applicable, unless 

17 the Secretary publishes in the Federal Register 

18 a justification for such significant modification. 

19 ‘‘(3) ADJUSTMENTS.— 

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

21 consider applying adjustments to the quality 

22 measures under this subsection taking into con23 sideration the studies under section 2(d) of the 

24 IMPACT Act of 2014. 


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

2 measures shall be risk adjusted, as determined 

3 appropriate by the Secretary. 

4 ‘‘(d) RESOURCE USE AND OTHER MEASURES.— 

5 ‘‘(1) REQUIREMENT FOR RESOURCE USE AND

6 OTHER MEASURES.—Not later than the specified ap7 plication date, as applicable to measures and PAC 

8 providers, the Secretary shall specify resource use 

9 and other measures on which PAC providers are re10 quired under the applicable reporting provisions to 

11 submit any necessary data specified by the Sec12 retary, which may include standardized assessment 

13 data in addition to claims data. Such measures shall 

14 be with respect to at least the following domains: 

15 ‘‘(A) Resource use measures, including 

16 total estimated Medicare spending per bene17 ficiary. 

18 ‘‘(B) Discharge to community. 

19 ‘‘(C) Measures to reflect all-condition risk20 adjusted potentially preventable hospital read21 mission rates. 

22 ‘‘(2) ALIGNING METHODOLOGY ADJUST23 MENTS.— 

24 ‘‘(A) LENGTH OF EPISODE.—With respect 

25 to the length of an episode, the Secretary shall, 


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1 to the extent the Secretary determines appro2 priate, align resource use and other measures 

3 specified under this subsection with respect to 

4 the domain described in paragraph (1)(A) with 

5 the methodology used for purposes of section 

6 1886(o)(2)(B)(ii). 

7 ‘‘(B) GEOGRAPHIC AND OTHER ADJUST8 MENTS.—The Secretary shall standardize meas9 ures with respect to the domain described in 

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

11 differences and payment differentials (and other 

12 adjustments, as applicable) consistent with the 

13 methodology published in the Federal Register 

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

15 through 51626), or any subsequent modifica16 tions made to the methodology. 

17 ‘‘(C) MEDICARE SPENDING PER BENE18 FICIARY.—The Secretary shall adjust, as appro19 priate, measures with respect to the domain de20 scribed in paragraph (1)(A) for the factors ap21 plied under section 1886(o)(2)(B)(ii). 

22 ‘‘(3) ADJUSTMENTS.— 

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

24 consider applying adjustments to the resource 

25 use and other measures specified under this 


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1 subsection with respect to the domain described 

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

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

4 Act of 2014. 

5 ‘‘(B) RISK ADJUSTMENT.—Such resource 

6 use and other measures shall be risk adjusted, 

7 as determined appropriate by the Secretary. 

8 ‘‘(e) MEASUREMENT IMPLEMENTATION PHASES; SE9 LECTION OF QUALITY MEASURES AND RESOURCE USE

10 AND OTHER MEASURES.— 

11 ‘‘(1) MEASUREMENT IMPLEMENTATION

12 PHASES.—In the case of quality measures specified 

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

14 measures specified under subsection (d)(1), the pro15 visions of this section shall be implemented in ac16 cordance with the following phases: 

17 ‘‘(A) INITIAL IMPLEMENTATION PHASE.— 

18 The initial implementation phase, with respect 

19 to such a measure, shall, in accordance with 

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

21 of— 

22 ‘‘(i) measure specification, including 

23 informing the public of the measure’s nu24 merator, denominator, exclusions, and any 


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1 other aspects the Secretary determines 

2 necessary; 

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

4 case of quality measures, requiring PAC 

5 providers to report data elements needed 

6 to calculate such a measure; and 

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

8 case of resource use and other measures, 

9 the use of claims data to calculate such a 

10 measure. 

11 ‘‘(B) SECOND IMPLEMENTATION PHASE.— 

12 The second implementation phase, with respect 

13 to such a measure, shall consist of the provision 

14 of feedback reports to PAC providers, in ac15 cordance with subsection (f). 

16 ‘‘(C) THIRD IMPLEMENTATION PHASE.— 

17 The third implementation phase, with respect to 

18 such a measure, shall consist of public reporting 

19 of PAC providers’ performance on such meas20 ure in accordance with subsection (g). 

21 ‘‘(2) CONSENSUS-BASED ENTITY.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), each measure specified by the Sec24 retary under this section shall be endorsed by 


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1 the entity with a contract under section 

2 1890(a). 

3 ‘‘(B) EXCEPTION.—In the case of a speci4 fied area or medical topic determined appro5 priate by the Secretary for which a feasible and 

6 practical measure has not been endorsed by the 

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

8 the Secretary may specify a measure that is not 

9 so endorsed as long as due consideration is 

10 given to measures that have been endorsed or 

11 adopted by a consensus organization identified 

12 by the Secretary. 

13 ‘‘(3) TREATMENT OF APPLICATION OF PRE14 RULEMAKING PROCESS (MEASURE APPLICATIONS

15 PARTNERSHIP PROCESS).— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graph (B), the provisions of section 1890A shall 

18 apply in the case of a quality measure specified 

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

20 measure specified under subsection (d). 

21 ‘‘(B) EXCEPTIONS.— 

22 ‘‘(i) EXPEDITED PROCEDURES.—For 

23 purposes of satisfying subparagraph (A), 

24 the Secretary may use expedited proce25 dures, such as ad-hoc reviews, as necVerDate Mar 15 2010 02:04 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2553.IS S2553

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1 essary, in the case of a quality measure 

2 specified under subsection (c) or a resource 

3 use or other measure specified in sub4 section (d) required with respect to data 

5 submissions under the applicable reporting 

6 provisions before one year after the speci7 fied application date applicable to such a 

8 measure and provider involved. 

9 ‘‘(ii) OPTION TO WAIVE PROVI10 SIONS.—The Secretary may waive the ap11 plication of the provisions of section 1890A 

12 in the case of a quality measure or re13 source use or other measure described in 

14 clause (i), if the application of such provi15 sions (including through the use of an ex16 pedited procedure described in such clause) 

17 would result in the inability of the Sec18 retary to satisfy any deadline specified in 

19 this section with respect to such measure. 

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

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

22 the specified application date, as applicable to PAC 

23 providers and quality measures and resource use and 

24 other measures under this section, the Secretary, in25 cluding through a process consistent with the procVerDate Mar 15 2010 02:04 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S2553.IS S2553

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1 ess applied under section 1886(b)(3)(B)(viii)(VII) 

2 for similar purposes, shall provide confidential feed3 back reports to such PAC providers on the perform4 ance of such providers with respect to such measures 

5 required under the applicable provisions. 

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

7 Secretary shall provide feedback reports described in 

8 paragraph (1) not less frequently than on a quar9 terly basis. Notwithstanding the previous sentence, 

10 with respect to measures described in such para11 graph that are reported on an annual basis, the Sec12 retary may provide such feedback reports on annual 

13 basis. 

14 ‘‘(g) PUBLIC REPORTING OF PAC PROVIDER PER15 FORMANCE.— 

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

17 paragraphs of this subsection, the Secretary shall 

18 provide for public reporting of PAC provider per19 formance on quality measures under subsection 

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

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

22 procedures for making available to the public infor23 mation regarding the performance of individual PAC 

24 providers with respect to such measures. 


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1 ‘‘(2) OPPORTUNITY TO REVIEW.—The proce2 dures under paragraph (1) shall ensure that a PAC 

3 provider has the opportunity to review and submit 

4 corrections to the data and information that is to be 

5 made public with respect to the provider prior to 

6 such data being made public. 

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

8 that the data and information described in para9 graph (1), with respect to a measure and PAC pro10 vider, is made publicly available beginning not later 

11 than two years after the specified application date 

12 applicable to such a measure and provider. 

13 ‘‘(4) COORDINATION WITH EXISTING PRO14 GRAMS.—Such procedures shall provide that data 

15 and information described in paragraph (1) with re16 spect to quality measures and resource use and 

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

18 shall be made publicly available consistent with the 

19 following provisions: 

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

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

22 ‘‘(B) In the case of skilled nursing facili23 ties, sections 1819(i) and 1919(i). 

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

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


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1 ‘‘(D) In the case of long-term care hos2 pitals, section 1886(m)(5)(E). 

3 ‘‘(h) REMOVING, SUSPENDING, OR ADDING MEAS4 URES.— 

5 ‘‘(1) IN GENERAL.—The Secretary may remove, 

6 suspend, or add a quality measure or resource use 

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

8 (d)(1), so long as, subject to paragraph (2), the Sec9 retary publishes in the Federal Register (with a no10 tice and comment period) a justification for such re11 moval, suspension, or addition. 

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

13 measure or resource use or other measure for which 

14 there is a reason to believe that the continued collec15 tion of such measure raises potential safety con16 cerns, the Secretary may promptly suspend or re17 move such measure and satisfy paragraph (1) by 

18 publishing in the Federal Register a justification for 

19 such suspension or removal in the next rulemaking 

20 cycle following such suspension or removal. 

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

22 QUALITY MEASURES, AND RESOURCE USE AND OTHER

23 MEASURES TO INFORM DISCHARGE PLANNING AND IN24 CORPORATE MEDICARE BENEFICIARY PREFERENCE.— 


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

2 2016, and periodically thereafter (but not less fre3 quently than once every 5 years), the Secretary shall 

4 promulgate regulations to modify conditions of par5 ticipation and subsequent interpretive guidance ap6 plicable to PAC providers, hospitals, and critical ac7 cess hospitals. Such regulations and interpretive 

8 guidance shall require such providers to take into 

9 account quality, resource use, and other measures 

10 under the applicable reporting provisions (which, as 

11 available, shall include measures specified under sub12 sections (c) and (d), and other relevant measures) in 

13 the discharge planning process. Specifically, such 

14 regulations and interpretive guidance shall address 

15 the settings to which a patient may be discharged in 

16 order to assist such PAC providers, patients, and 

17 families of such patients with discharge planning 

18 from inpatient settings, including subsection (d) hos19 pitals, critical access hospitals, and hospitals de20 scribed in section 1886(d)(1)(B)(v), and from PAC 

21 provider settings. In addition, such regulations and 

22 interpretive guidance shall include procedures to ad23 dress— 

24 ‘‘(A) treatment preferences of patients; 

25 and 


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1 ‘‘(B) goals of care of patients. 

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

3 applied pursuant to paragraph (1) shall be used to 

4 help inform and mandate the discharge planning 

5 process. 

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

7 not require an individual to be provided post-acute 

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

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

10 ‘‘(j) STAKEHOLDER INPUT.—Before the initial rule11 making process to implement this section, the Secretary 

12 shall allow for stakeholder input, such as through town 

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

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

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

16 Centers for Medicare & Medicaid Services Program Man17 agement Account, from the Federal Hospital Insurance 

18 Trust Fund under section 1817 and the Federal Supple19 mentary Medical Insurance Trust Fund under section 

20 1841, in such proportion as the Secretary determines ap21 propriate, of $130,000,000. Fifty percent of such amount 

22 shall be available on the date of the enactment of this sec23 tion and fifty percent of such amount shall be equally pro24 portioned for each of fiscal years 2015 through 2019. 

25 Such sums shall remain available until expended. 


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

2 or judicial review under sections 1869 and 1878 or other3 wise of the specification of standardized patient assess4 ment data required, the determination of measures, and 

5 the systems to report such standardized data under this 

6 section. 

7 ‘‘(m) NON-APPLICATION OF PAPERWORK REDUC8 TION ACT.—Chapter 35 of title 44, United States Code 

9 (commonly referred to as the ‘Paperwork Reduction Act 

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

11 referenced in subsection (a)(2)(B) that require modifica12 tion in order to achieve the standardization of patient as13 sessment data.’’. 

14 (b) STUDIES OF ALTERNATIVE PAC PAYMENT MOD15 ELS.— 

16 (1) MEDPAC.—Using data from the Post17 Acute Payment Reform Demonstration authorized 

18 under section 5008 of the Deficit Reduction Act of 

19 2005 (Public Law 109–171) or other data, as avail20 able, not later than June 30, 2016, the Medicare 

21 Payment Advisory Commission shall submit to Con22 gress a report that evaluates and recommends fea23 tures of PAC payment systems (as defined in section 

24 1899B(a)(2)(D) of the Social Security Act, as added 

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1 acute care payment system under title XVIII of the 

2 Social Security Act that establishes, payment rates 

3 according to characteristics of individuals (such as 

4 cognitive ability, functional status, and impairments) 

5 instead of according to the post-acute care setting 

6 where the Medicare beneficiary involved is treated. 

7 To the extent feasible, such report shall consider the 

8 impacts of moving from PAC payments systems (as 

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

10 1899B) in existence as of the date of the enactment 

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

12 under title XVIII of the Social Security Act. 

13 (2) RECOMMENDATIONS FOR PAC PROSPECTIVE

14 PAYMENT.— 

15 (A) REPORT BY SECRETARY.—Not later 

16 than 2 years after the date by which the Sec17 retary of Health and Human Services has col18 lected 2 years of data on quality measures 

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

20 by subsection (a), the Secretary shall, in con21 sultation with the Medicare Payment Advisory 

22 Commission and appropriate stakeholders, sub23 mit to Congress a report, including— 

24 (i) recommendations and a technical 

25 prototype, on a post-acute care prospective 


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•S 2553 IS

1 payment system under title XVIII of the 

2 Social Security Act that would— 

3 (I) in lieu of the rates that would 

4 otherwise apply under PAC payments 

5 systems (as defined in subsection 

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

7 base payments under such title, with 

8 respect to items and services fur9 nished to an individual by a PAC pro10 vider (as defined in subsection 

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

12 to individual characteristics (such as 

13 cognitive ability, functional status, 

14 and impairments) of such individual 

15 instead of the post-acute care setting 

16 in which the individual is furnished 

17 such items and services; 

18 (II) account for the clinical ap19 propriateness of items and services so 

20 furnished and Medicare beneficiary 

21 outcomes; 

22 (III) be designed to incorporate 

23 (or otherwise account for) standard24 ized patient assessment data under 

25 section 1899B; and 


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1 (IV) further clinical integration, 

2 such as by motivating greater coordi3 nation around a single condition or 

4 procedure to integrate hospital sys5 tems with PAC providers (as so de6 fined); 

7 (ii) recommendations on which Medi8 care fee-for-service regulations for post9 acute care payment systems under title 

10 XVIII of the Social Security Act should be 

11 altered (such as the skilled nursing facility 

12 3-day stay and inpatient rehabilitation fa13 cility 60-percent rule); 

14 (iii) an analysis of the impact of the 

15 recommended payment system described in 

16 clause (i) on Medicare beneficiary cost17 sharing, access to care, and choice of set18 ting; 

19 (iv) a projection of any potential re20 duction in expenditures under title XVIII 

21 of the Social Security Act that may be at22 tributable to the application of the rec23 ommended payment system described in 

24 clause (i); and 


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1 (v) a review of the value of subsection 

2 (d) hospitals (as defined in section 

3 1886(d)(1)(B) of the Social Security Act 

4 (42 U.S.C. 1395ww(d)(1)(B)), hospitals 

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

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

7 and critical access hospitals described in 

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

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

10 reporting to the Secretary standardized pa11 tient assessment data with respect to inpa12 tient hospital services furnished by such a 

13 hospital or critical access hospital to indi14 viduals who are entitled to benefits under 

15 part A of title XVIII of such Act or, as ap16 propriate, enrolled for benefits under part 

17 B of such title. 

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

19 the first June 30th following the date on which 

20 the report is required under subparagraph (A), 

21 the Medicare Payment Advisory Commission 

22 shall submit to Congress a report, including 

23 recommendations and a technical prototype, on 

24 a post-acute care prospective payment system 

25 under title XVIII of the Social Security Act 


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1 that would satisfy the criteria described in sub2 paragraph (A). 

3 (3) MEDICARE BENEFICIARY DEFINED.—For 

4 purposes of this subsection, the term ‘‘Medicare ben5 eficiary’’ has the meaning given such term in section 

6 1899B(a)(2) of the Social Security Act, as added by 

7 subsection (a). 

8 (c) PAYMENT CONSEQUENCES UNDER THE APPLICA9 BLE REPORTING PROVISIONS.— 

10 (1) HOME HEALTH AGENCIES.—Section 

11 1895(b)(3)(B)(v) of the Social Security Act (42 

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

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

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

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

16 2007’’ and inserting ‘‘Subject to subclause 

17 (IV)(cc), for 2007’’; 

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

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

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

21 subclause: 

22 ‘‘(IV) SUBMISSION OF ADDI23 TIONAL DATA.— 

24 ‘‘(aa) IN GENERAL.—For 

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1 fied application date (as defined 

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

3 1899B), as applicable with re4 spect to home health agencies 

5 and quality measures under sub6 section (c)(1) of such section and 

7 measures under subsection (d)(1) 

8 of such section, and each subse9 quent year, each home health 

10 agency shall submit to the Sec11 retary data on such quality meas12 ures and any necessary data 

13 specified by the Secretary under 

14 such subsection (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. 


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1 ‘‘(cc) NON-DUPLICATION.— 

2 To the extent such standardized 

3 data under subsection (b)(1) of 

4 such section 1899B, data on 

5 quality measures required under 

6 subsection (c)(1) of such section, 

7 or necessary data required under 

8 subsection (d)(1) of such section 

9 are duplicative of any other data 

10 required to be reported under 

11 this subclause, the submission of 

12 such standardized data, data on 

13 such quality measures, or nec14 essary data, respectively, shall be 

15 required under this subclause in 

16 lieu of the submission of such 

17 other data. 

18 ‘‘(dd) SUBMISSION.—Such 

19 data shall be submitted in the 

20 form and manner, and at the 

21 time, specified by the Secretary 

22 for purposes of subclause (II).’’. 

23 (2) INPATIENT REHABILITATION FACILITIES.— 

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

25 U.S.C. 1395ww(j)(7)) is amended— 


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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’’ and inserting ‘‘Subject to subpara6 graph (F)(iii), for fiscal year’’; 

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

8 ‘‘and subparagraph (F)(i)’’ after ‘‘subpara9 graph (C)’’; and 

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

11 subparagraph: 

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

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

14 beginning on the specified application date 

15 (as defined in subsection (a)(2)(E) of sec16 tion 1899B), as applicable with respect to 

17 inpatient rehabilitation facilities and qual18 ity measures under subsection (c)(1) of 

19 such section and measures under sub20 section (d)(1) of such section, and each 

21 subsequent fiscal year, in addition to such 

22 data on the quality measures described in 

23 subparagraph (C), each rehabilitation facil24 ity shall submit to the Secretary data on 

25 the quality measures under such subsection 


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

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

3 ‘‘(ii) STANDARDIZED PATIENT AS4 SESSMENT DATA.—For fiscal year 2019 

5 and each subsequent fiscal year, in addi6 tion to such data described in clause (i), 

7 each rehabilitation facility shall submit to 

8 the Secretary standardized patient assess9 ment data required under subsection (b)(1) 

10 of section 1899B. 

11 ‘‘(iii) NON-DUPLICATION.—To the ex12 tent such standardized data under sub13 section (b)(1) of such section 1899B, data 

14 on quality measures required under sub15 section (c)(1) of such section, or necessary 

16 data required under subsection (d)(1) of 

17 such section are duplicative of any other 

18 data required to be reported under this 

19 subparagraph, the submission of such 

20 standardized data, data on such quality 

21 measures, or necessary data, respectively, 

22 shall be required under this subparagraph 

23 in lieu of the submission of such other 

24 data. 


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1 ‘‘(iv) SUBMISSION.—Such data shall 

2 be submitted in the form and manner, and 

3 at the time, specified by the Secretary for 

4 purposes of subparagraph (C).’’. 

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

6 1886(m)(5) of the Social Security Act (42 U.S.C. 

7 1395ww(m)(5)) is amended— 

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

9 ‘‘subparagraph (C)’’ and inserting ‘‘subpara10 graphs (C) and (F)’’; 

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

12 rate year’’ and inserting ‘‘Subject to subpara13 graph (F)(iii), for rate year’’; 

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

15 ‘‘and subparagraph (F)(i)’’ after ‘‘subpara16 graph (C)’’; and 

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

18 subparagraph: 

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

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

21 beginning on the specified application date 

22 (as defined in subsection (a)(2)(E) of sec23 tion 1899B), as applicable with respect to 

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1 tion and measures under subsection (d)(1) 

2 of such section, and each subsequent rate 

3 year, in addition to the data on the quality 

4 measures described in subparagraph (C), 

5 each long-term care hospital (other than a 

6 hospital classified under subsection 

7 (b)(3)(B)(iv)(II)) shall submit to the Sec8 retary data on the quality measures under 

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

10 data specified by the Secretary under such 

11 subsection (d)(1). 

12 ‘‘(ii) STANDARDIZED PATIENT AS13 SESSMENT DATA.—For rate year 2019 and 

14 each subsequent rate year, in addition to 

15 such data described in clause (i), each 

16 long-term care hospital (other than a hos17 pital classified under subsection 

18 (b)(3)(B)(iv)(II)) shall submit to the Sec19 retary standardized patient assessment 

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

21 section 1899B. 

22 ‘‘(iii) NON-DUPLICATION.—To the ex23 tent such standardized data under sub24 section (b)(1) of such section 1899B, data 

25 on quality measures required under subVerDate Mar 15 2010 02:04 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00037 Fmt 6652 Sfmt 6201 E:\BILLS\S2553.IS S2553

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1 section (c)(1) of such section, or necessary 

2 data required under subsection (d)(1) of 

3 such section are duplicative of any other 

4 data required to be reported under this 

5 subparagraph, the submission of such 

6 standardized data, data on such quality 

7 measures, or necessary data, respectively, 

8 shall be required under this subparagraph 

9 in lieu of the submission of such other 

10 data. 

11 ‘‘(iv) SUBMISSION.—Such data shall 

12 be submitted in the form and manner, and 

13 at the time, specified by the Secretary for 

14 purposes of subparagraph (C).’’. 

15 (4) SKILLED NURSING FACILITIES.— 

16 (A) IN GENERAL.—Paragraph (6) of sec17 tion 1888(e) of the Social Security Act is 

18 amended to read as follows: 

19 ‘‘(6) REPORTING OF ASSESSMENT AND QUALITY

20 DATA.— 

21 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

22 TO REPORT.— 

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

24 beginning on or after the specified applica25 tion date (as defined in subsection 


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1 (a)(2)(E) of section 1899B), as applicable 

2 with respect to skilled nursing facilities 

3 and quality measures under subsection 

4 (c)(1) of such section and measures under 

5 subsection (d)(1) of such section, in the 

6 case of a skilled nursing facility that does 

7 not submit, in accordance with subpara8 graph (B) with respect to such a fiscal 

9 year, data on the quality measures speci10 fied under such subsection (c)(1), any nec11 essary data specified by the Secretary 

12 under such subsection (d)(1), and (for fis13 cal years beginning on or after October 1, 

14 2018) standardized patient assessment 

15 data specified under subsection (b)(1) of 

16 such section, after determining the per17 centage described in paragraph (5)(B)(i), 

18 and after application of paragraph 

19 (5)(B)(ii), the Secretary shall reduce such 

20 percentage for payment rates during such 

21 fiscal year by 2 percentage points. 

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

23 of this subparagraph may result in the per24 centage described in paragraph (5)(B)(i), 

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


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1 being less than 0.0 for a fiscal year, and 

2 may result in payment rates under this 

3 subsection for a fiscal year being less than 

4 such payment rates for the preceding fiscal 

5 year. 

6 ‘‘(iii) NONCUMULATIVE APPLICA7 TION.—Any reduction under clause (i) 

8 shall apply only with respect to the fiscal 

9 year involved and the Secretary shall not 

10 take into account such reduction in com11 puting the payment amount under this 

12 subsection for a subsequent fiscal year. 

13 ‘‘(B) ASSESSMENT AND MEASURE DATA.— 

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

15 facility, or a facility described in paragraph 

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

17 manner and within the timeframes pre18 scribed by the Secretary— 

19 ‘‘(I) the resident assessment data 

20 necessary to develop and implement 

21 the rates under this subsection; 

22 ‘‘(II) for fiscal years beginning 

23 on or after the specified application 

24 date (as defined in subsection 

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1 cable with respect to skilled nursing 

2 facilities and quality measures under 

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

4 measures under subsection (d)(1) of 

5 such section, data on such quality 

6 measures under such subsection (c)(1) 

7 and any necessary data specified by 

8 the Secretary under such subsection 

9 (d)(1); and 

10 ‘‘(III) for fiscal years beginning 

11 on or after October 1, 2018, stand12 ardized patient assessment data re13 quired under subsection (b)(1) of sec14 tion 1899B. 

15 To the extent such standardized data 

16 under subsection (b)(1) of such section, 

17 data on quality measures required under 

18 subsection (c)(1) of such section, or nec19 essary data required under subsection 

20 (d)(1) of such section are duplicative of 

21 any other data required to be reported 

22 under this subparagraph, the submission of 

23 such standardized data, data on such qual24 ity measures, or necessary data, respec25 tively, shall be required under this subVerDate Mar 15 2010 02:04 Jul 08, 2014 Jkt 039200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S2553.IS S2553

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1 paragraph in lieu of the submission of such 

2 other data. 

3 ‘‘(ii) USE OF STANDARD INSTRU4 MENT.—For purposes of meeting the re5 quirement under clause (i), a skilled nurs6 ing facility, or a facility described in para7 graph (7)(B), may submit the resident as8 sessment data required under section 

9 1819(b)(3), using the standard instrument 

10 designated by the State under section 

11 1819(e)(5).’’. 

12 (B) FUNDING FOR NURSING HOME COM13 PARE WEBSITE.—Section 1819(i) of the Social 

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

15 by adding at the end the following new para16 graph: 

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

18 to the Centers for Medicare & Medicaid Services 

19 Program Management Account, from the Federal 

20 Hospital Insurance Trust Fund under section 1817 

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

22 shall be available on the date of the enactment of 

23 this paragraph. Such sums shall remain available 

24 until expended. Such sums shall be used to imple25 ment section 1128I(g).’’. 


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1 (d) IMPROVING PAYMENT ACCURACY UNDER THE

2 PAC PAYMENT SYSTEMS AND OTHER MEDICARE PAY3 MENT SYSTEMS.— 

4 (1) STUDIES AND REPORTS OF EFFECT OF CER5 TAIN INFORMATION ON QUALITY AND RESOURCE

6 USE.— 

7 (A) STUDY USING EXISTING MEDICARE

8 DATA.— 

9 (i) STUDY.—The Secretary of Health 

10 and Human Services (in this subsection re11 ferred to as the ‘‘Secretary’’) shall conduct 

12 a study that examines the effect of individ13 uals’ socioeconomic status on quality meas14 ures and resource use and other measures 

15 for individuals under the Medicare pro16 gram under title XVIII of the Social Secu17 rity Act (42 U.S.C. 1395 et seq.) (such as 

18 to recognize that less healthy individuals 

19 may require more intensive interventions). 

20 The study shall use information collected 

21 on such individuals in carrying out such 

22 program, such as urban and rural location, 

23 eligibility for Medicaid under title XIX of 

24 such Act (42 U.S.C. 1396 et seq.) (recog25 nizing and accounting for varying Medicaid 


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1 eligibility across States), and eligibility for 

2 benefits under the supplemental security 

3 income (SSI) program. The Secretary shall 

4 carry out this paragraph acting through 

5 the Assistant Secretary for Planning and 

6 Evaluation. 

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

8 after the date of the enactment of this Act, 

9 the Secretary shall submit to Congress a 

10 report on the study conducted under clause 

11 (i). 

12 (B) STUDY USING OTHER DATA.— 

13 (i) STUDY.—The Secretary shall con14 duct a study that examines the impact of 

15 risk factors, such as those described in sec16 tion 1848(p)(3) of the Social Security Act 

17 (42 U.S.C. 1395w–4(p)(3)), race, health 

18 literacy, limited English proficiency (LEP), 

19 and Medicare beneficiary activation, on 

20 quality measures and resource use and 

21 other measures under the Medicare pro22 gram (such as to recognize that less 

23 healthy individuals may require more in24 tensive interventions). In conducting such 

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1 eral data and collect such additional data 

2 as may be necessary to complete the study. 

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

4 after the date of the enactment of this Act, 

5 the Secretary shall submit to Congress a 

6 report on the study conducted under clause 

7 (i). 

8 (C) EXAMINATION OF DATA IN CON9 DUCTING STUDIES.—In conducting the studies 

10 under subparagraphs (A) and (B), the Sec11 retary shall examine what non-Medicare data 

12 sets, such as data from the American Commu13 nity Survey (ACS), can be useful in conducting 

14 the types of studies under such paragraphs and 

15 how such data sets that are identified as useful 

16 can be coordinated with Medicare administra17 tive data in order to improve the overall data 

18 set available to do such studies and for the ad19 ministration of the Medicare program. 

20 (D) RECOMMENDATIONS TO ACCOUNT FOR

21 INFORMATION IN PAYMENT ADJUSTMENT

22 MECHANISMS.—If the studies conducted under 

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

24 between the factors examined in the studies and 

25 quality measures and resource use and other 


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•S 2553 IS

1 measures, then the Secretary shall also provide 

2 recommendations for how the Centers for Medi3 care & Medicaid Services should— 

4 (i) obtain access to the necessary data 

5 (if such data is not already being collected) 

6 on such factors, including recommenda7 tions on how to address barriers to the 

8 Centers in accessing such data; and 

9 (ii) account for such factors— 

10 (I) in quality measures, resource 

11 use measures, and other measures 

12 under subsections (c) and (d) of sec13 tion 1899B of the Social Security Act, 

14 as added by subsection (a), and under 

15 other applicable provisions of title 

16 XVIII of such Act (42 U.S.C. 1395 et 

17 seq.); and 

18 (II) in determining payment ad19 justments based on such measures in 

20 other applicable provisions of such 

21 title. 

22 (E) FUNDING.—There are hereby appro23 priated to the Secretary from the Federal Hos24 pital Insurance Trust Fund under section 1817 

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


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1 and the Federal Supplementary Medical Insur2 ance Trust Fund under section 1841 of such 

3 Act (42 U.S.C. 1395t) (in proportions deter4 mined appropriate by the Secretary) to carry 

5 out this paragraph $6,000,000, to remain avail6 able until expended. 

7 (2) CMS ACTIVITIES.— 

8 (A) IN GENERAL.—Taking into account 

9 the relevant studies conducted and rec10 ommendations made in reports under para11 graph (1) and, as appropriate, other informa12 tion, including information collected before com13 pletion of such studies and recommendations, 

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

15 Secretary determines appropriate and based on 

16 an individual’s health status and other fac17 tors— 

18 (i) assess appropriate adjustments to 

19 quality measures, resource use measures, 

20 and other measures under title XVIII of 

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

22 seq.) (including measures specified in sub23 sections (c) and (d) of section 1899B of 

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


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1 (ii) assess and implement appropriate 

2 adjustments to payments under such title. 

3 (B) ACCESSING DATA.—The Secretary 

4 shall collect or otherwise obtain access to the 

5 data necessary to carry out this paragraph 

6 through existing and new data sources. 

7 (C) PERIODIC ANALYSES.—The Secretary 

8 shall carry out periodic analyses, at least every 

9 3 years, based on the factors referred to in sub10 paragraph (A) so as to monitor changes in pos11 sible relationships. 

12 (D) FUNDING.—There are hereby appro13 priated to the Secretary from the Federal Hos14 pital Insurance Trust Fund under section 1817 

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

16 and the Federal Supplementary Medical Insur17 ance Trust Fund under section 1841 of such 

18 Act (42 U.S.C. 1395t) (in proportions deter19 mined appropriate by the Secretary) to carry 

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

21 available until expended. 

22 (3) STRATEGIC PLAN FOR ACCESSING RACE

23 AND ETHNICITY DATA.—Not later than 18 months 

24 after the date of the enactment of this Act, the Sec25 retary shall develop and report to Congress on a 


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1 strategic plan for collecting or otherwise accessing 

2 data on race and ethnicity for purposes of specifying 

3 quality measures and resource use and other meas4 ures under subsections (c) and (d) of section 1899B 

5 of the Social Security Act, as added by subsection 

6 (a), and, as the Secretary determines appropriate, 

7 other similar provision of, including payment adjust8 ments under, title XVIII of such Act (42 U.S.C. 

9 1395 et seq.). 

Æ 


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