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† HR 1892 EAS2 
‘‘(B) REQUIRED
USE.—Each request for 
payment, or bill submitted, for an outpatient 
physical therapy service or outpatient occupa-
tional therapy service furnished in whole or in 
part by a therapy assistant (as so defined) on or 
after January 1, 2020, shall include the modifier 
established under subparagraph (A) for each 
such service. 
‘‘(3) IMPLEMENTATION.—The Secretary shall im-
plement this subsection through notice and comment 
rulemaking.’’. 
SEC. 53108. REDUCTION FOR NON-EMERGENCY ESRD AMBU-
LANCE TRANSPORTS. 
Section 1834(l)(15) of the Social Security Act (42. 
U.S.C. 1395m(l)(15)) is amended by striking ‘‘on or after 
October 1, 2013’’ and inserting ‘‘during the period begin-
ning on October 1, 2013, and ending on September 30, 
2018, and by 23 percent for such services furnished on or 
after October 1, 2018’’. 
SEC. 53109. HOSPITAL TRANSFER POLICY FOR EARLY DIS-
CHARGES TO HOSPICE CARE. 
(a) IN GENERAL.—Section 1886(d)(5)(J) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(J)) is amended— 
(1) in clause (ii)—
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† HR 1892 EAS2 
(A) in subclause (III), by striking ‘‘or’’ at 
the end; 
(B) by redesignating subclause (IV) as sub-
clause (V); and 
(C) by inserting after subclause (III) the 
following new subclause: 
‘‘(IV) for discharges occurring on or after Octo-
ber 1, 2018, is provided hospice care by a hospice pro-
gram; or’’; and 
(2) in clause (iv)— 
(A) by inserting after the first sentence the 
following new sentence: ‘‘The Secretary shall in-
clude in the proposed rule published for fiscal 
year 2019, a description of the effect of clause 
(ii)(IV).’’; and 
(B) in subclause (I), by striking ‘‘and 
(III)’’ and inserting ‘‘(III), and, in the case of 
proposed and final rules for fiscal year 2019 and 
subsequent fiscal years, (IV)’’. 
(b) MEDPAC EVALUATION AND REPORT.— 
(1) EVALUATION.—The Medicare Payment Advi-
sory Commission (in this subsection referred to as the 
‘‘Commission’’) shall conduct an evaluation of the ef-
fects of the amendments made by subsection (a), in-
cluding the effects on—
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† HR 1892 EAS2 
(A) the numbers of discharges of patients 
from an inpatient hospital setting to a hospice 
program; 
(B) the lengths of stays of patients in an in-
patient hospital setting who are discharged to a 
hospice program; 
(C) spending under the Medicare program 
under title XVIII of the Social Security Act; and 
(D) other areas determined appropriate by 
the Commission. 
(2) CONSIDERATION.—In conducting the evalua-
tion under paragraph (1), the Commission shall con-
sider factors such as whether the timely access to hos-
pice care by patients admitted to a hospital has been 
affected through changes to hospital policies or behav-
iors made as a result of such amendments. 
(3) PRELIMINARY
RESULTS.—Not later than 
March 15, 2020, the Commission shall provide Con-
gress with preliminary results on the evaluation being 
conducted under paragraph (1). 
(4) REPORT.—Not later than March 15, 2021, 
the Commission shall submit to Congress a report on 
the evaluation conducted under paragraph (1).
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† HR 1892 EAS2 
SEC. 53110. MEDICARE PAYMENT UPDATE FOR HOME 
HEALTH SERVICES. 
Section 1895(b)(3)(B) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)) is amended— 
(1) in clause (iii), in the last sentence, by insert-
ing before the period at the end the following: ‘‘and 
for 2020 shall be 1.5 percent’’; and 
(2) in clause (vi), by inserting ‘‘and 2020’’ after 
‘‘except 2018’’. 
SEC. 53111. MEDICARE PAYMENT UPDATE FOR SKILLED 
NURSING FACILITIES. 
Section 1888(e)(5)(B) of the Social Security Act (42 
U.S.C. 1395yy(e)(5)(B)) is amended— 
(1) in clause (i), by striking ‘‘and (iii)’’ and in-
serting ‘‘, (iii), and (iv)’’; 
(2) in clause (ii), by striking ‘‘clause (iii)’’ and 
inserting ‘‘clauses (iii) and (iv)’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iv) SPECIAL RULE FOR FISCAL YEAR 
2019.—For fiscal year 2019 (or other simi-
lar annual period specified in clause (i)), 
the skilled nursing facility market basket 
percentage, after application of clause (ii), 
is equal to 2.4 percent.’’.
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† HR 1892 EAS2 
SEC. 53112. PREVENTING THE ARTIFICIAL INFLATION OF 
STAR RATINGS AFTER THE CONSOLIDATION 
OF MEDICARE ADVANTAGE PLANS OFFERED 
BY THE SAME ORGANIZATION. 
Section 1853(o)(4) of the Social Security Act (42 
U.S.C. 1395w–23(o)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(D) SPECIAL RULE TO PREVENT THE ARTI-
FICIAL INFLATION OF STAR RATINGS AFTER THE 
CONSOLIDATION OF MEDICARE ADVANTAGE PLANS 
OFFERED BY A SINGLE ORGANIZATION.— 
‘‘(i) IN GENERAL.—If— 
‘‘(I) a Medicare Advantage orga-
nization has entered into more than 
one contract with the Secretary with 
respect to the offering of Medicare Ad-
vantage plans; and 
‘‘(II) on or after January 1, 2019, 
the Secretary approves a request from 
the organization to consolidate the 
plans under one or more contract (in 
this subparagraph referred to as a 
‘closed contract’) with the plans offered 
under a separate contract (in this sub-
paragraph referred to as the ‘con-
tinuing contract’);
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† HR 1892 EAS2 
with respect to the continuing contract, the 
Secretary shall adjust the quality rating 
under the 5-star rating system and any 
quality increase under this subsection and 
rebate amounts under section 1854 to reflect 
an enrollment-weighted average of scores or 
ratings for the continuing and closed con-
tracts, as determined appropriate by the 
Secretary. 
‘‘(ii) APPLICATION.—An adjustment 
under clause (i) shall apply for any year 
for which the quality rating of the con-
tinuing contract is based primarily on a 
measurement period that is prior to the 
first year in which a closed contract is no 
longer offered.’’. 
SEC. 53113. SUNSETTING EXCLUSION OF BIOSIMILARS 
FROM MEDICARE PART D COVERAGE GAP DIS-
COUNT PROGRAM. 
Section 1860D–14A(g)(2)(A) of the Social Security 
Act (42 U.S.C. 1395w–114a(g)(2)(A)) is amended by insert-
ing ‘‘, with respect to a plan year before 2019,’’ after ‘‘other 
than’’.
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† HR 1892 EAS2 
SEC. 53114. ADJUSTMENTS TO MEDICARE PART B AND PART 
D PREMIUM SUBSIDIES FOR HIGHER INCOME 
INDIVIDUALS. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i) of the So-
cial Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amend-
ed— 
(1) in subclause (II), in the matter preceding the 
table, by striking ‘‘years beginning with’’; and 
(2) by adding at the end the following new sub-
clause: 
‘‘(III) Subject to paragraph (5), 
for years beginning with 2019: 
‘‘If the modified adjusted gross income is: ........
The applicable 
percentage is:
More than $85,000 but not more than $107,000 .................
35 percent
More than $107,000 but not more than $133,500 ...............
50 percent
More than $133,500 but not more than $160,000 ...............
65 percent
More than $160,000 but less than $500,000 .........................
80 percent
At least $500,000 ....................................................................
85 percent.’’. 
(b) JOINT RETURNS.—Section 1839(i)(3)(C)(ii) of the 
Social Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is 
amended by inserting before the period the following: ‘‘ex-
cept, with respect to the dollar amounts applied in the last 
row of the table under subclause (III) of such clause (and 
the second dollar amount specified in the second to last row 
of such table), clause (i) shall be applied by substituting 
dollar amounts which are 150 percent of such dollar 
amounts for the calendar year’’.
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† HR 1892 EAS2 
(c) INFLATION ADJUSTMENT.—Section 1839(i)(5) of 
the Social Security Act (42 U.S.C. 1395r(i)(5)) is amend-
ed— 
(1) in subparagraph (A), by striking ‘‘In the 
case’’ and inserting ‘‘Subject to subparagraph (C), in 
the case’’; 
(2) in subparagraph (B), by striking ‘‘subpara-
graph (A)’’ and inserting ‘‘subparagraph (A) or (C)’’; 
and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) TREATMENT
OF
ADJUSTMENTS
FOR 
CERTAIN HIGHER INCOME INDIVIDUALS.— 
‘‘(i) IN GENERAL.—Subparagraph (A) 
shall not apply with respect to each dollar 
amount in paragraph (3) of $500,000. 
‘‘(ii) ADJUSTMENT BEGINNING 2028.— 
In the case of any calendar year beginning 
after 2027, each dollar amount in para-
graph (3) of $500,000 shall be increased by 
an amount equal to— 
‘‘(I) such dollar amount, multi-
plied by 
‘‘(II) the percentage (if any) by 
which the average of the Consumer
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† HR 1892 EAS2 
Price Index for all urban consumers 
(United States city average) for the 12- 
month period ending with August of 
the preceding calendar year exceeds 
such average for the 12-month period 
ending with August 2026.’’. 
SEC. 53115. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$220,000,000’’ and inserting ‘‘$0’’. 
SEC. 53116. CLOSING THE DONUT HOLE FOR SENIORS. 
(a) CLOSING DONUT HOLE SOONER.—Section 1860D– 
2(b)(2)(D) of the Social Security Act (42 U.S.C. 1395w– 
102(b)(2)(D))— 
(1) in clause (i), by amending subclause (I) to 
read as follows: 
‘‘(I) equal to the difference be-
tween— 
‘‘(aa) the applicable gap per-
centage (specified in clause (ii) 
for the year); and 
‘‘(bb) the discount percentage 
specified 
in 
section 
1860D– 
14A(g)(4)(A) for such applicable
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† HR 1892 EAS2 
drugs (or, in the case of a year 
after 2018, 50 percent); or’’; and 
(2) in clause (ii)— 
(A) in subclause (IV), by adding ‘‘and’’ at 
the end; 
(B) by striking subclause (V); and 
(C) in subclause (VI)— 
(i) by striking ‘‘2020’’ and inserting 
‘‘2019’’; and 
(ii) by redesignating such subclause as 
subclause (V). 
(b) LOWERING DISCOUNTED PRICE.—Section 1860D– 
14A(g)(4)(A) of the Social Security Act (42 U.S.C. 1395w– 
114a(g)(4)(A)) is amended by inserting ‘‘(or, with respect 
to a plan year after plan year 2018, 30 percent)’’ after ‘‘50 
percent’’. 
SEC. 53117. MODERNIZING CHILD SUPPORT ENFORCEMENT 
FEES. 
(a) IN GENERAL.—Section 454(6)(B)(ii) of the Social 
Security Act (42 U.S.C. 654(6)(B)(ii)) is amended— 
(1) by striking ‘‘$25’’ and inserting ‘‘$35’’; and 
(2) by striking ‘‘$500’’ each place it appears and 
inserting ‘‘$550’’. 
(b) EFFECTIVE DATE.—
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† HR 1892 EAS2 
(1) IN
GENERAL.—The amendments made by 
subsection (a) shall take effect on the 1st day of the 
1st fiscal year that begins on or after the date of the 
enactment of this Act, and shall apply to payments 
under part D of title IV of the Social Security Act 
(42 U.S.C. 651 et seq.) for calendar quarters begin-
ning on or after such 1st day. 
(2) DELAY PERMITTED IF STATE LEGISLATION 
REQUIRED.—If the Secretary of Health and Human 
Services determines that State legislation (other than 
legislation appropriating funds) is required in order 
for a State plan developed pursuant to part D of title 
IV of the Social Security Act (42 U.S.C. 651 et seq.) 
to meet the requirements imposed by the amendment 
made by subsection (a), the plan shall not be regarded 
as failing to meet such requirements before the 1st 
day of the 1st calendar quarter beginning after the 
first regular session of the State legislature that be-
gins after the date of the enactment of this Act. For 
purposes of the preceding sentence, if the State has a 
2-year legislative session, each year of the session is 
deemed to be a separate regular session of the State 
legislature.
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† HR 1892 EAS2 
SEC. 53118. INCREASING EFFICIENCY OF PRISON DATA RE-
PORTING. 
(a) IN GENERAL.—Section 1611(e)(1)(I)(i)(II) of the 
Social Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is 
amended by striking ‘‘30 days’’ each place it appears and 
inserting ‘‘15 days’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply with respect to any payment made 
by the Commissioner of Social Security pursuant to section 
1611(e)(1)(I)(i)(II) of the Social Security Act (42 U.S.C. 
1382(e)(1)(I)(i)(II)) (as amended by such subsection) on or 
after the date that is 6 months after the date of enactment 
of this Act. 
SEC. 53119. PREVENTION AND PUBLIC HEALTH FUND. 
Section 4002(b) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 300u–11(b)), as amended by sec-
tion 3103 of Public Law 115–96, is amended by striking 
paragraphs (4) through (9) and inserting the following: 
‘‘(4) for fiscal year 2019, $900,000,000; 
‘‘(5) for each of fiscal years 2020 and 2021, 
$950,000,000; 
‘‘(6) for each of fiscal years 2022 and 2023, 
$1,000,000,000; 
‘‘(7) for each of fiscal years 2024 and 2025, 
$1,300,000,000;
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† HR 1892 EAS2 
‘‘(8) for each of fiscal years 2026 and 2027, 
$1,800,000,000; and 
‘‘(9) for fiscal year 2028 and each fiscal year 
thereafter, $2,000,000,000.’’. 
DIVISION F—IMPROVEMENTS TO 
AGRICULTURE PROGRAMS 
SEC. 60101. (a) TREATMENT OF SEED COTTON.— 
(1) DESIGNATION OF SEED COTTON AS A COV-
ERED COMMODITY.—Section 1111(6) of the Agricul-
tural Act of 2014 (7 U.S.C. 9011(6)) is amended— 
(A) by striking ‘‘The term’’ and inserting 
the following: 
‘‘(A) IN GENERAL.—The term’’; and 
(B) by adding at the end the following: 
‘‘(B) INCLUSION.—Effective beginning with 
the 2018 crop year, the term ‘covered commodity’ 
includes seed cotton.’’. 
(2) REFERENCE PRICE FOR SEED COTTON.—Sec-
tion 1111(18) of the Agricultural Act of 2014 (7 
U.S.C. 9011(18)) is amended by adding at the end 
the following: 
‘‘(O) For seed cotton, $0.367 per pound.’’. 
(3) DEFINITION OF SEED COTTON.—Section 1111 
of the Agricultural Act of 2014 (7 U.S.C. 9011) is 
amended—
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† HR 1892 EAS2 
(A) by redesignating paragraphs (20) 
through (24) as paragraphs (21) through (25), 
respectively; and 
(B) by inserting after paragraph (19) the 
following: 
‘‘(20) SEED
COTTON.—The term ‘seed cotton’ 
means unginned upland cotton that includes both lint 
and seed.’’. 
(4) PAYMENT YIELD.—Section 1113 of the Agri-
cultural Act of 2014 (7 U.S.C. 9013) is amended by 
adding at the end the following: 
‘‘(e) PAYMENT YIELD FOR SEED COTTON.— 
‘‘(1) PAYMENT
YIELD.—Subject to paragraph 
(2), the payment yield for seed cotton for a farm shall 
be equal to 2.4 times the payment yield for upland 
cotton for the farm established under section 
1104(e)(3) of the Food, Conservation, and Energy Act 
of 2008 (7 U.S.C. 8714(e)(3)) (as in effect on Sep-
tember 30, 2013). 
‘‘(2) UPDATE.—At the sole discretion of the 
owner of a farm with a yield for upland cotton de-
scribed in paragraph (1), the owner of the farm shall 
have a 1-time opportunity to update the payment 
yield for upland cotton for the farm, as provided in
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† HR 1892 EAS2 
subsection (d), for the purpose of calculating the pay-
ment yield for seed cotton under paragraph (1).’’. 
(5) PAYMENT ACRES.—Section 1114(b) of the Ag-
ricultural Act of 2014 (7 U.S.C. 9014(b)) is amended 
by adding at the end the following: 
‘‘(4) SEED COTTON.— 
‘‘(A) IN GENERAL.—Not later than 90 days 
after the date of enactment of this paragraph, the 
Secretary shall require the owner of a farm to al-
locate all generic base acres on the farm under 
subparagraph (B) or (C), or both. 
‘‘(B) NO
RECENT
HISTORY
OF
COVERED 
COMMODITIES.—In the case of a farm on which 
no covered commodities (including seed cotton) 
were planted or were prevented from being plant-
ed at any time during the 2009 through 2016 
crop years, the owner of such farm shall allocate 
generic base acres on the farm to unassigned 
crop base for which no payments may be made 
under section 1116 or 1117. 
‘‘(C) RECENT HISTORY OF COVERED COM-
MODITIES.—In the case of a farm not described 
in subparagraph (B), the owner of such farm 
shall allocate generic base acres on the farm—
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† HR 1892 EAS2 
‘‘(i) subject to subparagraph (D), to 
seed cotton base acres in a quantity equal 
to the greater of— 
‘‘(I) 80 percent of the generic base 
acres on the farm; or 
‘‘(II) the average number of seed 
cotton acres planted or prevented from 
being planted on the farm during the 
2009 through 2012 crop years (not to 
exceed the total generic base acres on 
the farm); or 
‘‘(ii) to base acres for covered commod-
ities (including seed cotton), by applying 
subparagraphs (B), (D), (E), and (F) of 
section 1112(a)(3). 
‘‘(D) TREATMENT
OF
RESIDUAL
GENERIC 
BASE ACRES.—In the case of a farm on which 
generic base acres are allocated under subpara-
graph (C)(i), the residual generic base acres shall 
be allocated to unassigned crop base for which no 
payments may be made under section 1116 or 
1117. 
‘‘(E) EFFECT OF FAILURE TO ALLOCATE.— 
In the case of a farm not described in subpara-
graph (B) for which the owner of the farm fails
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† HR 1892 EAS2 
to make an election under subparagraph (C), the 
owner of the farm shall be deemed to have elected 
to allocate all generic base acres in accordance 
with subparagraph (C)(i).’’. 
(6) RECORDKEEPING
REGARDING
UNASSIGNED 
CROP BASE.—Section 1114 of the Agricultural Act of 
2014 (7 U.S.C. 9014) is amended by adding at the 
end the following: 
‘‘(f) UNASSIGNED CROP BASE.—The Secretary shall 
maintain information on generic base acres on a farm allo-
cated as unassigned crop base under subsection (b)(4).’’. 
(7) SPECIAL ELECTION PERIOD FOR PRICE LOSS 
COVERAGE OR AGRICULTURE RISK COVERAGE.—Sec-
tion 1115 of the Agricultural Act of 2014 (7 U.S.C. 
9015) is amended— 
(A) in subsection (a), by striking ‘‘For’’ and 
inserting ‘‘Except as provided in subsection (g), 
for’’; and 
(B) by adding at the end the following: 
‘‘(g) SPECIAL ELECTION.— 
‘‘(1) IN GENERAL.—In the case of acres allocated 
to seed cotton on a farm, all of the producers on the 
farm shall be given the opportunity to make a new 
1-time election under subsection (a) to reflect the des-
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† HR 1892 EAS2 
ignation of seed cotton as a covered commodity for 
that crop year under section 1111(6)(B). 
‘‘(2) EFFECT OF FAILURE TO MAKE UNANIMOUS 
ELECTION.—If all the producers on a farm fail to 
make a unanimous election under paragraph (1), the 
producers on the farm shall be deemed to have elected 
price loss coverage under section 1116 for acres allo-
cated on the farm to seed cotton.’’. 
(8) EFFECTIVE PRICE.—Section 1116 of the Ag-
ricultural Act of 2014 (7 U.S.C. 9016) is amended by 
adding at the end the following: 
‘‘(h) EFFECTIVE PRICE FOR SEED COTTON.— 
‘‘(1) IN GENERAL.—The effective price for seed 
cotton under subsection (b) shall be equal to the mar-
keting year average price for seed cotton, as cal-
culated under paragraph (2). 
‘‘(2) CALCULATION.—The marketing year aver-
age price for seed cotton for a crop year shall be equal 
to the quotient obtained by dividing— 
‘‘(A) the sum obtained by adding— 
‘‘(i) the product obtained by multi-
plying— 
‘‘(I) the upland cotton lint mar-
keting year average price; and