referred to as the ‘‘pilot program’’) to test the impact of 
eliminating the Medicare 190-day lifetime limit on— 
(1) promoting value; 
(2) expanding choice; and 
(3) aligning inpatient mental health benefits 
with the inpatient physical health care benefits 
under the Medicare program. 
(b) DEFINITIONS.—In this section: 
(1) APPLICABLE BENEFICIARY.—The term ‘‘ap-
plicable beneficiary’’ means an individual who— 
(A) is entitled to, or enrolled for, benefits 
under part A, and enrolled for benefits under 
part B, of the Medicare program; 
(B) is admitted to a qualifying institution 
participating in the demonstration project; and 
(C) but for the pilot program established 
under this section, would otherwise receive ben-
efits for inpatient psychiatric services under the 
Medicare program if the services were provided 
in a general acute care hospital. 
(2) INPATIENT PSYCHIATRIC HOSPITAL SERV-
ICES.—The term ‘‘inpatient psychiatric hospital 
services’’ has the meaning given such term in section 
1861(c) of the Social Security Act (42 U.S.C. 
1395x(c)). 
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(3) MEDICARE 190-DAY LIFETIME LIMIT.—The 
term ‘‘Medicare 190-day lifetime limit’’ means the 
190-day lifetime limitation imposed on inpatient psy-
chiatric hospital services under section 1812(b)(3) of 
the Social Security Act (42 U.S.C. 1395d(b)(3)). 
(c) PROGRAM DETAILS.— 
(1) DURATION AND STARTING DATE.— 
(A) STARTING DATE.—The pilot program 
shall begin no later than January 1, 2021. 
(B) DURATION.—Subject to subparagraph 
(C), the pilot program shall be conducted for a 
period of 7 years. 
(C) EXPANSION.—The Secretary may, at 
any time after the pilot program has operated 
for a period of at least 3 years expand the du-
ration and scope of the pilot program, to the 
extent determined appropriate by the Secretary, 
if— 
(i) the Secretary determines that such 
expansion is expected— 
(I) to reduce (or not to result in 
any increase in) net expenditures 
under the Medicare program without 
reducing the quality of care; or 
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(II) to improve the quality of 
care without increasing such net ex-
penditures; 
(ii) the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies 
that such expansion would reduce spending 
under the Medicare program; and 
(iii) the Secretary determines that 
such expansion would not deny or limit the 
coverage or provision of benefits under the 
Medicare program for applicable bene-
ficiaries. 
(2) WAIVER OF MEDICARE 190-DAY LIFETIME 
LIMIT.—The Medicare 190-day lifetime limit shall 
not apply to applicable beneficiaries receiving inpa-
tient psychiatric services at a participating institu-
tion under the pilot program. 
(3) PARTICIPATING
PROVIDERS
OF
SERVICES 
AND SUPPLIERS.— 
(A) IN GENERAL.—Only institutions par-
ticipating in the demonstration project may 
submit an application to the Secretary to pro-
vide inpatient psychiatric services under the 
pilot program. 
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(B) REQUIREMENTS.—The Secretary may 
develop additional requirements for institutions 
to participate in the pilot program. Such re-
quirements may include the collection and re-
porting of data related to the reasonable costs 
of graduate medical education. 
(4) QUALITY MEASURES.— 
(A) IN GENERAL.—The Secretary shall es-
tablish quality measures related to care pro-
vided by qualifying institutions participating in 
the pilot program, which measures shall include 
at least measures of the following: 
(i) Reducing rates of avoidable hos-
pital readmissions. 
(ii) Rates of discharge to the commu-
nity. 
(iii) Rates of admission to an emer-
gency room after a hospitalization. 
(iv) Other measures, including meas-
ures of patient outcomes, determined ap-
propriate by the Secretary. 
(B) REPORTING ON QUALITY MEASURES.— 
A qualifying institution shall submit (in a form 
and manner specified by the Secretary) data to 
the Secretary on quality measures established 
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under subparagraph (A) during each year in 
which the institution is participating in the pilot 
program. 
(d) WAIVER.—The Secretary shall waive such provi-
sions of titles XI and XVIII of the Social Security Act 
as may be necessary to carry out the pilot program. 
(e) INDEPENDENT EVALUATION AND REPORTS ON 
PILOT PROGRAM.— 
(1) INDEPENDENT
EVALUATION.—The Sec-
retary shall conduct an independent evaluation of 
the pilot program, including the extent to which the 
pilot program has— 
(A) improved quality measures established 
under subsection (c)(4)(A); 
(B) improved health outcomes; 
(C) improved patient satisfaction; and 
(D) reduced spending under the Medicare 
program. 
(2) REPORT.—Not later than December 31, 
2027, the Secretary shall submit to Congress a re-
port on the evaluation conducted under paragraph 
(1). 
(3) COORDINATION WITH EXPANDING CHOICE 
FOR MEDICAID INPATIENT PSYCHIATRIC HOSPITAL 
SERVICES
DEMONSTRATION
PROJECT.—The Sec-
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retary may combine the independent evaluation and 
reports required under this section and the reports 
required under the demonstration project under sec-
tion 2(f). 
(f) BUDGET NEUTRALITY.—With respect to the pe-
riod of the pilot program under subsection (c)(1) occurring 
before any expansion under subparagraph (C) of such sub-
section, the Secretary shall ensure that the program does 
not result in a net increase in the aggregate expenditures 
under the Medicare program for such period above the 
level of such expenditures if the pilot program had not 
been implemented. The Secretary may make such adjust-
ments to payments under the Medicare program as is nec-
essary to carry out the previous sentence. 
Æ 
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