(C) EXAMINATION
OF
DATA
IN
CON-
DUCTING STUDIES.—In conducting the studies 
under subparagraphs (A) and (B), the Sec-
retary shall examine what non-Medicare data 
sets, such as data from the American Commu-
nity Survey (ACS), can be useful in conducting 
the types of studies under such paragraphs and 
how such data sets that are identified as useful 
can be coordinated with Medicare administra-
tive data in order to improve the overall data 
set available to do such studies and for the ad-
ministration of the Medicare program. 
(D) RECOMMENDATIONS TO ACCOUNT FOR 
INFORMATION
IN
PAYMENT
ADJUSTMENT 
MECHANISMS.—If the studies conducted under 
subparagraphs (A) and (B) find a relationship 
between the factors examined in the studies and 
quality measures and resource use and other 
measures, then the Secretary shall also provide 
recommendations for how the Centers for Medi-
care & Medicaid Services should— 
(i) obtain access to the necessary data 
(if such data is not already being collected) 
on such factors, including recommenda-
tions on how to address barriers to the 
Centers in accessing such data; and 
(ii) account for such factors— 
(I) in quality measures, resource 
use measures, and other measures 
under title XVIII of the Social Secu-
rity Act (including such measures 
specified under subsections (c) and 
(d) of section 1899B of such Act, as 
added by subsection (a)); and 
(II) in determining payment ad-
justments based on such measures in 
other applicable provisions of such 
title. 
(E) FUNDING.—There are hereby appro-
priated to the Secretary from the Federal Hos-
pital Insurance Trust Fund under section 1817 
of the Social Security Act (42 U.S.C. 1395i) 
and the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841 of such 
Act (42 U.S.C. 1395t) (in proportions deter-
mined appropriate by the Secretary) to carry 
out this paragraph $6,000,000, to remain avail-
able until expended. 
(2) CMS ACTIVITIES.—
(A) IN
GENERAL.—Taking into account 
the 
relevant 
studies 
conducted 
and 
rec-
ommendations made in reports under para-
graph (1) and, as appropriate, other informa-
tion, including information collected before com-
pletion of such studies and recommendations, 
the Secretary, on an ongoing basis, shall, as the 
Secretary determines appropriate and based on 
an individual’s health status and other fac-
tors— 
(i) assess appropriate adjustments to 
quality measures, resource use measures, 
and other measures under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et 
seq.) (including measures specified in sub-
sections (c) and (d) of section 1899B of 
such Act, as added by subsection (a)); and 
(ii) assess and implement appropriate 
adjustments to payments under such title 
based on measures described in clause (i). 
(B) ACCESSING
DATA.—The Secretary 
shall collect or otherwise obtain access to the 
data necessary to carry out this paragraph 
through existing and new data sources.
(C) PERIODIC ANALYSES.—The Secretary 
shall carry out periodic analyses, at least every 
3 years, based on the factors referred to in sub-
paragraph (A) so as to monitor changes in pos-
sible relationships. 
(D) FUNDING.—There are hereby appro-
priated to the Secretary from the Federal Hos-
pital Insurance Trust Fund under section 1817 
of the Social Security Act (42 U.S.C. 1395i) 
and the Federal Supplementary Medical Insur-
ance Trust Fund under section 1841 of such 
Act (42 U.S.C. 1395t) (in proportions deter-
mined appropriate by the Secretary) to carry 
out this paragraph $10,000,000, to remain 
available until expended. 
(3) STRATEGIC
PLAN
FOR
ACCESSING
RACE 
AND ETHNICITY DATA.—Not later than 18 months 
after the date of the enactment of this Act, the Sec-
retary shall develop and report to Congress on a 
strategic plan for collecting or otherwise accessing 
data on race and ethnicity for purposes of specifying 
quality measures and resource use and other meas-
ures under subsections (c) and (d) of section 1899B 
of the Social Security Act, as added by subsection 
(a), and, as the Secretary determines appropriate,
other similar provisions of, including payment ad-
justments under, title XVIII of such Act (42 U.S.C. 
1395 et seq.). 
SEC. 3. HOSPICE CARE. 
(a) HOSPICE SURVEY REQUIREMENT.— 
(1) IN GENERAL.—Section 1861(dd)(4) of the 
Social Security Act (42 U.S.C. 1395x(dd)(4)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(C) Any entity that is certified as a hospice program 
shall be subject to a standard survey by an appropriate 
State or local survey agency, or an approved accreditation 
agency, as determined by the Secretary, not less fre-
quently than once every 36 months beginning 6 months 
after the date of the enactment of this subparagraph and 
ending September 30, 2025.’’. 
(2) FUNDING.—For purposes of carrying out 
subparagraph (C) of section 1861(dd)(4) of the So-
cial Security Act (42 U.S.C. 1395x(dd)(4)), as 
added by paragraph (1), there shall be transferred 
from the Federal Hospital Insurance Trust Fund 
under section 1817 of such Act (42 U.S.C. 1395i) 
to the Centers for Medicare & Medicaid Services 
Program Management Account—
(A) $25,000,000 for fiscal years 2015 
through 2017, to be made available for such 
purposes in equal parts for each such fiscal 
year; and 
(B) $45,000,000 for fiscal years 2018 
through 2025, to be made available for such 
purposes in equal parts for each such fiscal 
year. 
(b) HOSPICE PROGRAM ELIGIBILITY RECERTIFI-
CATION TECHNICAL CORRECTION TO APPLY LIMITATION 
ON LIABILITY OF BENEFICIARY RULES.—Section 1879 of 
the Social Security Act (42 U.S.C. 1395pp) is amended 
by adding at the end the following new subsection: 
‘‘(i) The provisions of this section shall apply with 
respect to a denial of a payment under this title by reason 
of section 1814(a)(7)(E) in the same manner as such pro-
visions apply with respect to a denial of a payment under 
this title by reason of section 1862(a)(1).’’. 
(c) REVISION TO REQUIREMENT FOR MEDICAL RE-
VIEW OF CERTAIN HOSPICE CARE.—Section 1814(a)(7) 
of the Social Security Act (42 U.S.C. 1395f(a)(7)) is 
amended— 
(1) in subparagraph (C), by striking ‘‘and’’ at 
the end;
(2) in subparagraph (D), in the matter pre-
ceding clause (i), by inserting ‘‘(and, in the case of 
clause (ii), before the date of enactment of subpara-
graph (E))’’ after ‘‘2011’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) on and after the date of enactment of 
this subparagraph, in the case of hospice care 
provided an individual for more than 180 days 
by a hospice program for which the number of 
such cases for such program comprises more 
than a percent (specified by the Secretary) of 
the total number of all cases of individuals pro-
vided hospice care by the program under this 
title, the hospice care provided to such indi-
vidual is medically reviewed (in accordance with 
procedures established by the Secretary); and’’. 
(d) UPDATE
OF HOSPICE AGGREGATE PAYMENT 
CAP.—Section 1814(i)(2)(B) of the Social Security Act 
(42 U.S.C. 1395f(i)(2)(B)) is amended— 
(1) by striking ‘‘(B) For purposes’’ and insert-
ing ‘‘(B)(i) Except as provided in clause (ii), for 
purposes’’; and 
(2) by adding at the end the following:
‘‘(ii) For purposes of subparagraph (A) for account-
ing years that end after September 30, 2016, and before 
October 1, 2025, the ‘cap amount’ is the cap amount 
under this subparagraph for the preceding accounting 
year updated by the percentage update to payment rates 
for hospice care under paragraph (1)(C) for services fur-
nished during the fiscal year beginning on the October 1 
preceding the beginning of the accounting year (including 
the application of any productivity or other adjustment 
under clause (iv) of that paragraph). 
‘‘(iii) For accounting years that end after September 
30, 2025, the cap amount shall be computed under clause 
(i) as if clause (ii) had never applied.’’. 
(e) MEDICARE IMPROVEMENT FUND.—Section 1898 
of the Social Security Act (42 U.S.C. 1395iii) is amend-
ed— 
(1) by amending the heading to read as follows: 
‘‘MEDICARE IMPROVEMENT FUND’’; 
(2) by amending subsection (a) to read as fol-
lows: 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish under this title a Medicare Improvement Fund (in this 
section referred to as the ‘Fund’) which shall be available 
to the Secretary to make improvements under the original 
Medicare fee-for-service program under parts A and B for
individuals entitled to, or enrolled for, benefits under part 
or enrolled under part B including adjustments to pay-
ments for items and services furnished by providers of 
services and suppliers under such original Medicare fee- 
for-service program.’’; 
(3) in subsection (b)(1), by striking ‘‘during’’ 
and all that follows and inserting ‘‘during and after 
fiscal year 2020, $195,000,000.’’; and 
(4) in subsection (b)(2), by striking ‘‘from the 
Federal’’ and all that follows and inserting ‘‘from 
the Federal Hospital Insurance Trust Fund and the 
Federal Supplementary Medical Insurance Trust 
Fund in such proportion as the Secretary determines 
appropriate.’’. 
Passed the House of Representatives September 16, 
2014. 
Attest: 
Clerk.
113TH CONGRESS 
2D SESSION 
H. R. 4994 
AN ACT 
To amend title XVIII of the Social Security Act to 
provide for standardized post-acute care assess-
ment data for quality, payment, and discharge 
planning, and for other purposes.