113 
‘‘(G) OPERATIONAL
LIST
OF
CARE
EPI-
SODE AND PATIENT CONDITION GROUPS AND 
CODES.—Not later than 180 days after the end 
of the comment period described in subpara-
graph (F), taking into account the comments 
received under such subparagraph, the Sec-
retary shall post on the Internet website of the 
Centers for Medicare & Medicaid Services an 
operational list of care episode and patient con-
dition codes (and the criteria and characteris-
tics assigned to such code). 
‘‘(H) SUBSEQUENT REVISIONS.—Not later 
than November 1 of each year (beginning with 
2017), the Secretary shall, through rulemaking, 
make revisions to the operational lists of care 
episode and patient condition codes as the Sec-
retary determines may be appropriate. Such re-
visions may be based on experience, new infor-
mation 
developed 
pursuant 
to 
subsection 
(n)(9)(A), and input from the physician spe-
cialty societies, applicable practitioner organiza-
tions, and other stakeholders, including rep-
resentatives of individuals entitled to benefits 
under part A or enrolled under this part.
114 
‘‘(3) ATTRIBUTION
OF
PATIENTS
TO
PHYSI-
CIANS OR PRACTITIONERS.— 
‘‘(A) IN GENERAL.—In order to facilitate 
the attribution of patients and episodes (in 
whole or in part) to one or more physicians or 
applicable practitioners furnishing items and 
services, the Secretary shall undertake the steps 
described in the succeeding provisions of this 
paragraph. 
‘‘(B) DEVELOPMENT
OF
PATIENT
RELA-
TIONSHIP CATEGORIES AND CODES.—The Sec-
retary shall develop patient relationship cat-
egories and codes that define and distinguish 
the relationship and responsibility of a physi-
cian or applicable practitioner with a patient at 
the time of furnishing an item or service. Such 
patient relationship categories shall include dif-
ferent relationships of the physician or applica-
ble practitioner to the patient (and the codes 
may reflect combinations of such categories), 
such as a physician or applicable practitioner 
who— 
‘‘(i) considers themself to have the 
primary responsibility for the general and
115 
ongoing care for the patient over extended 
periods of time; 
‘‘(ii) considers themself to be the lead 
physician or practitioner and who furnishes 
items and services and coordinates care 
furnished by other physicians or practi-
tioners for the patient during an acute epi-
sode; 
‘‘(iii) furnishes items and services to 
the patient on a continuing basis during an 
acute episode of care, but in a supportive 
rather than a lead role; 
‘‘(iv) furnishes items and services to 
the patient on an occasional basis, usually 
at the request of another physician or 
practitioner; or 
‘‘(v) furnishes items and services only 
as ordered by another physician or practi-
tioner. 
‘‘(C) DRAFT LIST OF PATIENT RELATION-
SHIP CATEGORIES AND CODES.—Not later than 
270 days after the date of the enactment of this 
subsection, the Secretary shall post on the 
Internet website of the Centers for Medicare & 
Medicaid Services a draft list of the patient re-
116 
lationship categories and codes developed under 
subparagraph (B). 
‘‘(D) STAKEHOLDER
INPUT.—The Sec-
retary shall seek, through the date that is 60 
days after the Secretary posts the list pursuant 
to subparagraph (C), comments from physician 
specialty societies, applicable practitioner orga-
nizations, and other stakeholders, including rep-
resentatives of individuals entitled to benefits 
under part A or enrolled under this part, re-
garding the patient relationship categories and 
codes posted under subparagraph (C). In seek-
ing such comments, the Secretary shall use one 
or more mechanisms (other than notice and 
comment rulemaking) that may include open 
door forums, town hall meetings, or other ap-
propriate mechanisms. 
‘‘(E) OPERATIONAL LIST OF PATIENT RE-
LATIONSHIP
CATEGORIES
AND
CODES.—Not 
later than 180 days after the end of the com-
ment period described in subparagraph (D), 
taking into account the comments received 
under such subparagraph, the Secretary shall 
post on the Internet website of the Centers for
117 
Medicare & Medicaid Services an operational 
list of patient relationship categories and codes. 
‘‘(F) SUBSEQUENT REVISIONS.—Not later 
than November 1 of each year (beginning with 
2017), the Secretary shall, through rulemaking, 
make revisions to the operational list of patient 
relationship categories and codes as the Sec-
retary determines appropriate. Such revisions 
may be based on experience, new information 
developed pursuant to subsection (n)(9)(A), and 
input from the physician specialty societies, ap-
plicable practitioner organizations, and other 
stakeholders, including representatives of indi-
viduals entitled to benefits under part A or en-
rolled under this part. 
‘‘(4) REPORTING
OF
INFORMATION
FOR
RE-
SOURCE USE MEASUREMENT.—Claims submitted for 
items and services furnished by a physician or appli-
cable practitioner on or after January 1, 2017, shall, 
as determined appropriate by the Secretary, in-
clude— 
‘‘(A) applicable codes established under 
paragraphs (2) and (3); and 
‘‘(B) the national provider identifier of the 
ordering physician or applicable practitioner (if
118 
different from the billing physician or applicable 
practitioner). 
‘‘(5) METHODOLOGY FOR RESOURCE USE ANAL-
YSIS.— 
‘‘(A) IN GENERAL.—In order to evaluate 
the resources used to treat patients (with re-
spect to care episode and patient condition 
groups), the Secretary shall— 
‘‘(i) use the patient relationship codes 
reported on claims pursuant to paragraph 
(4) to attribute patients (in whole or in 
part) to one or more physicians and appli-
cable practitioners; 
‘‘(ii) use the care episode and patient 
condition codes reported on claims pursu-
ant to paragraph (4) as a basis to compare 
similar patients and care episodes and pa-
tient condition groups; and 
‘‘(iii) conduct an analysis of resource 
use (with respect to care episodes and pa-
tient condition groups of such patients), as 
the Secretary determines appropriate. 
‘‘(B) ANALYSIS OF PATIENTS OF PHYSI-
CIANS AND PRACTITIONERS.—In conducting the 
analysis described in subparagraph (A)(iii) with
119 
respect to patients attributed to physicians and 
applicable practitioners, the Secretary shall, as 
feasible— 
‘‘(i) use the claims data experience of 
such patients by patient condition codes 
during a common period, such as 12 
months; and 
‘‘(ii) use the claims data experience of 
such patients by care episode codes— 
‘‘(I) in the case of episodes with-
out a hospitalization, during periods 
of time (such as the number of days) 
determined appropriate by the Sec-
retary; and 
‘‘(II) in the case of episodes with 
a hospitalization, during periods of 
time (such as the number of days) be-
fore, during, and after the hospitaliza-
tion. 
‘‘(C) MEASUREMENT OF RESOURCE USE.— 
In measuring such resource use, the Sec-
retary— 
‘‘(i) shall use per patient total allowed 
charges for all services under part A and 
this part (and, if the Secretary determines
120 
appropriate, part D) for the analysis of pa-
tient resource use, by care episode codes 
and by patient condition codes; and 
‘‘(ii) may, as determined appropriate, 
use other measures of allowed charges 
(such as subtotals for categories of items 
and services) and measures of utilization of 
items and services (such as frequency of 
specific items and services and the ratio of 
specific items and services among attrib-
uted patients or episodes). 
‘‘(D) STAKEHOLDER
INPUT.—The Sec-
retary shall seek comments from the physician 
specialty societies, applicable practitioner orga-
nizations, and other stakeholders, including rep-
resentatives of individuals entitled to benefits 
under part A or enrolled under this part, re-
garding the resource use methodology estab-
lished pursuant to this paragraph. In seeking 
comments the Secretary shall use one or more 
mechanisms (other than notice and comment 
rulemaking) that may include open door fo-
rums, town hall meetings, or other appropriate 
mechanisms.
121 
‘‘(6) IMPLEMENTATION.—To the extent that 
the Secretary contracts with an entity to carry out 
any part of the provisions of this subsection, the 
Secretary may not contract with an entity or an en-
tity with a subcontract if the entity or subcon-
tracting entity currently makes recommendations to 
the Secretary on relative values for services under 
the fee schedule for physicians’ services under this 
section. 
‘‘(7) LIMITATION.—There shall be no adminis-
trative or judicial review under section 1869, section 
1878, or otherwise of— 
‘‘(A) care episode and patient condition 
groups and codes established under paragraph 
(2); 
‘‘(B) patient relationship categories and 
codes established under paragraph (3); and 
‘‘(C) measurement of, and analyses of re-
source use with respect to, care episode and pa-
tient condition codes and patient relationship 
codes pursuant to paragraph (5). 
‘‘(8) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code, shall not apply to this section. 
‘‘(9) DEFINITIONS.—In this section:
122 
‘‘(A) PHYSICIAN.—The term ‘physician’ 
has the meaning given such term in section 
1861(r)(1). 
‘‘(B) APPLICABLE
PRACTITIONER.—The 
term ‘applicable practitioner’ means— 
‘‘(i) a physician assistant, nurse prac-
titioner, and clinical nurse specialist (as 
such 
terms 
are 
defined 
in 
section 
1861(aa)(5)), and a certified registered 
nurse anesthetist (as defined in section 
1861(bb)(2)); and 
‘‘(ii) beginning January 1, 2018, such 
other eligible professionals (as defined in 
subsection (k)(3)(B)) as specified by the 
Secretary. 
‘‘(10) CLARIFICATION.—The provisions of sec-
tions 1890(b)(7) and 1890A shall not apply to this 
subsection.’’. 
SEC. 3. PRIORITIES AND FUNDING FOR MEASURE DEVEL-
OPMENT. 
Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4), as amended by subsections (c) and (g) of sec-
tion 2, is further amended by inserting at the end the fol-
lowing new subsection:
123 
‘‘(s) PRIORITIES AND FUNDING FOR MEASURE DE-
VELOPMENT.— 
‘‘(1) PLAN IDENTIFYING MEASURE DEVELOP-
MENT PRIORITIES AND TIMELINES.— 
‘‘(A) DRAFT
MEASURE
DEVELOPMENT 
PLAN.—Not later than January 1, 2015, the 
Secretary shall develop, and post on the Inter-
net website of the Centers for Medicare & Med-
icaid Services, a draft plan for the development 
of quality measures for application under the 
applicable provisions (as defined in paragraph 
(5)). Under such plan the Secretary shall— 
‘‘(i) address how measures used by 
private payers and integrated delivery sys-
tems could be incorporated under title 
XVIII; 
‘‘(ii) describe how coordination, to the 
extent possible, will occur across organiza-
tions developing such measures; and 
‘‘(iii) take into account how clinical 
best practices and clinical practice guide-
lines should be used in the development of 
quality measures.
125 
‘‘(D) PRIORITIES.—In developing the draft 
plan under this paragraph, the Secretary shall 
give priority to the following types of measures: 
‘‘(i) Outcome measures, including pa-
tient reported outcome and functional sta-
tus measures. 
‘‘(ii) Patient experience measures. 
‘‘(iii) Care coordination measures. 
‘‘(iv) Measures of appropriate use of 
services, including measures of over use. 
‘‘(E) STAKEHOLDER
INPUT.—The Sec-
retary shall accept through March 1, 2015, 
comments on the draft plan posted under para-
graph (1)(A) from the public, including health 
care providers, payers, consumers, and other 
stakeholders. 
‘‘(F) 
FINAL
MEASURE
DEVELOPMENT 
PLAN.—Not later than May 1, 2015, taking 
into account the comments received under this 
subparagraph, the Secretary shall finalize the 
plan and post on the Internet website of the 
Centers for Medicare & Medicaid Services an 
operational plan for the development of quality 
measures for use under the applicable provi-
126 
sions. Such plan shall be updated as appro-
priate. 
‘‘(2) CONTRACTS AND OTHER ARRANGEMENTS 
FOR QUALITY MEASURE DEVELOPMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts or other arrangements with 
entities for the purpose of developing, improv-
ing, updating, or expanding in accordance with 
the plan under paragraph (1) quality measures 
for application under the applicable provisions. 
Such entities shall include organizations with 
quality measure development expertise. 
‘‘(B) PRIORITIZATION.— 
‘‘(i) IN
GENERAL.—In entering into 
contracts or other arrangements under 
subparagraph (A), the Secretary shall give 
priority to the development of the types of 
measures described in paragraph (1)(D). 
‘‘(ii) CONSIDERATION.—In selecting 
measures for development under this sub-
section, the Secretary shall consider— 
‘‘(I) 
whether 
such 
measures 
would be electronically specified; and
127 
‘‘(II) clinical practice guidelines 
to the extent that such guidelines 
exist. 
‘‘(3) ANNUAL REPORT BY THE SECRETARY.— 
‘‘(A) IN GENERAL.—Not later than May 1, 
2016, and annually thereafter, the Secretary 
shall post on the Internet website of the Cen-
ters for Medicare & Medicaid Services a report 
on the progress made in developing quality 
measures for application under the applicable 
provisions. 
‘‘(B) REQUIREMENTS.—Each report sub-
mitted pursuant to subparagraph (A) shall in-
clude the following: 
‘‘(i) A description of the Secretary’s 
efforts to implement this paragraph. 
‘‘(ii) With respect to the measures de-
veloped during the previous year— 
‘‘(I) a description of the total 
number of quality measures developed 
and the types of such measures, such 
as an outcome or patient experience 
measure; 
‘‘(II) the name of each measure 
developed;
128 
‘‘(III) the name of the developer 
and steward of each measure; 
‘‘(IV) with respect to each type 
of measure, an estimate of the total 
amount expended under this title to 
develop all measures of such type; and 
‘‘(V) whether the measure would 
be electronically specified. 
‘‘(iii) With respect to measures in de-
velopment at the time of the report— 
‘‘(I) the information described in 
clause (ii), if available; and 
‘‘(II) a timeline for completion of 
the development of such measures. 
‘‘(iv) A description of any updates to 
the plan under paragraph (1) (including 
newly identified gaps and the status of pre-
viously identified gaps) and the inventory 
of measures applicable under the applicable 
provisions. 
‘‘(v) Other information the Secretary 
determines to be appropriate. 
‘‘(4) STAKEHOLDER
INPUT.—With respect to 
paragraph (1), the Secretary shall seek stakeholder 
input with respect to—
129 
‘‘(A) the identification of gaps where no 
quality measures exist, particularly with respect 
to the types of measures described in paragraph 
(1)(D); 
‘‘(B) prioritizing quality measure develop-
ment to address such gaps; and 
‘‘(C) other areas related to quality measure 
development determined appropriate by the Sec-
retary. 
‘‘(5) 
DEFINITION
OF
APPLICABLE
PROVI-
SIONS.—In this subsection, the term ‘applicable pro-
visions’ means the following provisions: 
‘‘(A) Subsection (q)(2)(B)(i). 
‘‘(B) Section 1833(z)(2)(C). 
‘‘(6) FUNDING.—For purposes of carrying out 
this subsection, the Secretary shall provide for the 
transfer, from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841, of 
$15,000,000 to the Centers for Medicare & Medicaid 
Services Program Management Account for each of 
fiscal years 2014 through 2018. Amounts trans-
ferred under this paragraph shall remain available 
through the end of fiscal year 2021.’’.