To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value-based purchasing program under the Medicare program, and for other purposes.

To amend title XVIII of the Social Security Act to improve measurements under the skilled nursing facility value-based purchasing program under the Medicare program, and for other purposes. 1. Improving measurements under the skilled nursing facility value-based purchasing program under the Medicare program (a) In general Section 1888(h) of the Social Security Act ( 42 U.S.C. 1395yy(h) (1) in paragraph (1), by adding at the end the following new subparagraph: (C) Exclusions With respect to payments for services furnished on or after October 1, 2021, this subsection shall not apply to a facility for which there are not a minimum number (as determined by the Secretary) of— (i) cases for the measures that apply to the facility for the performance period for the applicable fiscal year; or (ii) measures that apply to the facility for the performance period for the applicable fiscal year. ; (2) in paragraph (2)(A)— (A) by striking The Secretary shall apply The Secretary— (i) shall apply ; (B) by striking the period at the end and inserting ; and (C) by adding at the end the following: (ii) may, with respect to payments for services furnished on or after October 1, 2022, apply additional measures determined appropriate by the Secretary, which may include measures of functional status, patient safety, care coordination, or patient experience. Subject to the succeeding sentence, in the case that the Secretary applies additional measures under clause (ii), the Secretary shall consider and apply, as appropriate, quality measures specified under section 1899B(c)(1). In no case may the Secretary apply more than 10 measures under this subparagraph. ; (3) in subparagraph (A) of each of paragraphs (3) and (4), by striking measure measures (4) by adding at the end the following new paragraph: (12) Validation (A) In general The Secretary shall apply to the measures applied under this subsection and the data submitted under subsection (e)(6) a process to validate such measures and data, as appropriate, which may be similar to the process specified in section 1886(b)(3)(B)(viii)(XI) for validating inpatient hospital measures. (B) Funding For purposes of carrying out this paragraph, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund established under section 1817, of $5,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for each of fiscal years 2022 through 2024. . (b) Report by MedPAC Not later than March 15, 2021, the Medicare Payment Advisory Commission shall submit to Congress a report on establishing a prototype value-based payment program under a unified prospective payment system for post-acute care services under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 (1) shall— (A) consider design elements such as— (i) measures that are important to the Medicare program and to beneficiaries under such program; (ii) methodologies for scoring provider performance and effects on payment; and (iii) other elements determined appropriate by the Commission; and (B) analyze the effects of implementing such prototype program; and (2) may— (A) discuss the possible effects, with respect to the Medicare program, on program spending, post-acute care providers, patient outcomes, and other effects determined appropriate by the Commission; and (B) include recommendations with respect to such prototype program, as determined appropriate by the Commission, to Congress and the Secretary of Health and Human Services.

Summary: This bill modifies requirements relating to the Medicare skilled nursing facility (SNF) value-based purchasing program, which provides incentive payments to SNFs based on their quality of care. Currently, all Medicare SNFs are included in the program, and their quality of care is determined based on a hospital readmissions measure. The bill excludes from the program SNFs for which there is not a minimum number of applicable cases or measures, as set by the Centers for Medicare &amp; Medicaid Services (CMS), for the performance period. Additionally, the bill allows the CMS to apply up to 10 additional quality measures, including measures relating to patient safety and care coordination.