231 
† HR 1892 EAS2 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2017. 
SEC. 41110. EXCEPTION FROM PRIVATE FOUNDATION EX-
CESS BUSINESS HOLDING TAX FOR INDE-
PENDENTLY-OPERATED 
PHILANTHROPIC 
BUSINESS HOLDINGS. 
(a) IN GENERAL.—Section 4943 is amended by adding 
at the end the following new subsection: 
‘‘(g) EXCEPTION FOR CERTAIN HOLDINGS LIMITED TO 
INDEPENDENTLY-OPERATED PHILANTHROPIC BUSINESS.— 
‘‘(1) IN
GENERAL.—Subsection (a) shall not 
apply with respect to the holdings of a private foun-
dation in any business enterprise which meets the re-
quirements of paragraphs (2), (3), and (4) for the 
taxable year. 
‘‘(2) OWNERSHIP.—The requirements of this 
paragraph are met if— 
‘‘(A) 100 percent of the voting stock in the 
business enterprise is held by the private founda-
tion at all times during the taxable year, and 
‘‘(B) all the private foundation’s ownership 
interests in the business enterprise were acquired 
by means other than by purchase. 
‘‘(3) ALL PROFITS TO CHARITY.—
232 
† HR 1892 EAS2 
‘‘(A) IN
GENERAL.—The requirements of 
this paragraph are met if the business enterprise, 
not later than 120 days after the close of the tax-
able year, distributes an amount equal to its net 
operating income for such taxable year to the 
private foundation. 
‘‘(B) NET OPERATING INCOME.—For pur-
poses of this paragraph, the net operating in-
come of any business enterprise for any taxable 
year is an amount equal to the gross income of 
the business enterprise for the taxable year, re-
duced by the sum of— 
‘‘(i) the deductions allowed by chapter 
1 for the taxable year which are directly 
connected with the production of such in-
come, 
‘‘(ii) the tax imposed by chapter 1 on 
the business enterprise for the taxable year, 
and 
‘‘(iii) an amount for a reasonable re-
serve for working capital and other business 
needs of the business enterprise. 
‘‘(4) INDEPENDENT
OPERATION.—The require-
ments of this paragraph are met if, at all times dur-
ing the taxable year—
233 
† HR 1892 EAS2 
‘‘(A) no substantial contributor (as defined 
in section 4958(c)(3)(C)) to the private founda-
tion or family member (as determined under sec-
tion 4958(f)(4)) of such a contributor is a direc-
tor, officer, trustee, manager, employee, or con-
tractor of the business enterprise (or an indi-
vidual having powers or responsibilities similar 
to any of the foregoing), 
‘‘(B) at least a majority of the board of di-
rectors of the private foundation are persons who 
are not— 
‘‘(i) directors or officers of the business 
enterprise, or 
‘‘(ii) family members (as so deter-
mined) of a substantial contributor (as so 
defined) to the private foundation, and 
‘‘(C) there is no loan outstanding from the 
business enterprise to a substantial contributor 
(as so defined) to the private foundation or to 
any family member of such a contributor (as so 
determined). 
‘‘(5) CERTAIN DEEMED PRIVATE FOUNDATIONS 
EXCLUDED.—This subsection shall not apply to—
234 
† HR 1892 EAS2 
‘‘(A) any fund or organization treated as a 
private foundation for purposes of this section by 
reason of subsection (e) or (f), 
‘‘(B) 
any 
trust 
described 
in 
section 
4947(a)(1) (relating to charitable trusts), and 
‘‘(C) 
any 
trust 
described 
in 
section 
4947(a)(2) (relating to split-interest trusts).’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2017. 
SEC. 41111. RULE OF CONSTRUCTION FOR CRAFT BEV-
ERAGE MODERNIZATION AND TAX REFORM. 
(a) IN GENERAL.—Subpart A of part IX of subtitle 
C of title I of Public Law 115–97 is amended by adding 
at the end the following new section: 
‘‘SEC. 13809. RULE OF CONSTRUCTION. 
‘‘Nothing in this subpart, the amendments made by 
this subpart, or any regulation promulgated under this sub-
part or the amendments made by this subpart, shall be con-
strued to preempt, supersede, or otherwise limit or restrict 
any State, local, or tribal law that prohibits or regulates 
the production or sale of distilled spirits, wine, or malt bev-
erages.’’.
235 
† HR 1892 EAS2 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall take effect as if included in Public Law 115– 
97. 
SEC. 
41112. 
SIMPLIFICATION 
OF 
RULES 
REGARDING 
RECORDS, STATEMENTS, AND RETURNS. 
(a) IN GENERAL.—Subsection (a) of section 5555 is 
amended by adding at the end the following: ‘‘For calendar 
quarters beginning after the date of the enactment of this 
sentence, and before January 1, 2020, the Secretary shall 
permit a person to employ a unified system for any records, 
statements, and returns required to be kept, rendered, or 
made under this section for any beer produced in the brew-
ery for which the tax imposed by section 5051 has been de-
termined, including any beer which has been removed for 
consumption on the premises of the brewery.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to calendar quarters beginning after the 
date of the enactment of this Act. 
SEC. 41113. MODIFICATION OF RULES GOVERNING HARD-
SHIP DISTRIBUTIONS. 
(a) IN GENERAL.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of the Treasury 
shall modify Treasury Regulation section 1.401(k)– 
1(d)(3)(iv)(E) to—
236 
† HR 1892 EAS2 
(1) delete the 6-month prohibition on contribu-
tions imposed by paragraph (2) thereof, and 
(2) make any other modifications necessary to 
carry out the purposes of section 401(k)(2)(B)(i)(IV) 
of the Internal Revenue Code of 1986. 
(b) EFFECTIVE DATE.—The revised regulations under 
this section shall apply to plan years beginning after De-
cember 31, 2018. 
SEC. 41114. MODIFICATION OF RULES RELATING TO HARD-
SHIP WITHDRAWALS FROM CASH OR DE-
FERRED ARRANGEMENTS. 
(a) IN GENERAL.—Section 401(k) is amended by add-
ing at the end the following: 
‘‘(14) SPECIAL RULES RELATING TO HARDSHIP 
WITHDRAWALS.—For 
purposes 
of 
paragraph 
(2)(B)(i)(IV)— 
‘‘(A) AMOUNTS
WHICH
MAY
BE
WITH-
DRAWN.—The following amounts may be distrib-
uted upon hardship of the employee: 
‘‘(i) Contributions to a profit-sharing 
or stock bonus plan to which section 
402(e)(3) applies. 
‘‘(ii) Qualified nonelective contribu-
tions (as defined in subsection (m)(4)(C)).
237 
† HR 1892 EAS2 
‘‘(iii) Qualified matching contributions 
described in paragraph (3)(D)(ii)(I). 
‘‘(iv) Earnings on any contributions 
described in clause (i), (ii), or (iii). 
‘‘(B) NO
REQUIREMENT
TO
TAKE
AVAIL-
ABLE LOAN.—A distribution shall not be treated 
as failing to be made upon the hardship of an 
employee solely because the employee does not 
take any available loan under the plan.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
401(k)(2)(B)(i)(IV) is amended to read as follows: 
‘‘(IV) subject to the provisions of 
paragraph (14), upon hardship of the 
employee, or’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to plan years beginning after December 
31, 2018. 
SEC. 41115. OPPORTUNITY ZONES RULE FOR PUERTO RICO. 
(a) IN GENERAL.—Subsection (b) of section 1400Z– 
1 is amended by adding at the end the following new para-
graph: 
‘‘(3) SPECIAL RULE FOR PUERTO RICO.—Each 
population census tract in Puerto Rico that is a low- 
income community shall be deemed to be certified and
238 
† HR 1892 EAS2 
designated as a qualified opportunity zone, effective 
on the date of the enactment of Public Law 115–97.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1400Z– 
1(d)(1) is amended by inserting ‘‘and subsection (b)(3)’’ 
after ‘‘paragraph (2)’’. 
SEC. 41116. TAX HOME OF CERTAIN CITIZENS OR RESI-
DENTS 
OF 
THE 
UNITED 
STATES 
LIVING 
ABROAD. 
(a) IN GENERAL.—Paragraph (3) of section 911(d) is 
amended by inserting before the period at the end of the 
second sentence the following: ‘‘, unless such individual is 
serving in an area designated by the President of the United 
States by Executive order as a combat zone for purposes 
of section 112 in support of the Armed Forces of the United 
States’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2017. 
SEC. 41117. TREATMENT OF FOREIGN PERSONS FOR RE-
TURNS RELATING TO PAYMENTS MADE IN 
SETTLEMENT OF PAYMENT CARD AND THIRD 
PARTY NETWORK TRANSACTIONS. 
(a) IN GENERAL.—Section 6050W(d)(1)(B) is amend-
ed by adding at the end the following: ‘‘Notwithstanding 
the preceding sentence, a person with only a foreign address
239 
† HR 1892 EAS2 
shall not be treated as a participating payee with respect 
to any payment settlement entity solely because such person 
receives payments from such payment settlement entity in 
dollars.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to returns for calendar years beginning 
after December 31, 2017. 
SEC. 41118. REPEAL OF SHIFT IN TIME OF PAYMENT OF 
CORPORATE ESTIMATED TAXES. 
The Trade Preferences Extension Act of 2015 is 
amended by striking section 803 (relating to time for pay-
ment of corporate estimated taxes). 
SEC. 41119. ENHANCEMENT OF CARBON DIOXIDE SEQUES-
TRATION CREDIT. 
(a) IN GENERAL.—Section 45Q is amended to read as 
follows: 
‘‘SEC. 45Q. CREDIT FOR CARBON OXIDE SEQUESTRATION. 
‘‘(a) GENERAL RULE.—For purposes of section 38, the 
carbon oxide sequestration credit for any taxable year is 
an amount equal to the sum of— 
‘‘(1) $20 per metric ton of qualified carbon oxide 
which is— 
‘‘(A) captured by the taxpayer using carbon 
capture equipment which is originally placed in 
service at a qualified facility before the date of
240 
† HR 1892 EAS2 
the enactment of the Bipartisan Budget Act of 
2018, and 
‘‘(B) disposed of by the taxpayer in secure 
geological storage and not used by the taxpayer 
as described in paragraph (2)(B), 
‘‘(2) $10 per metric ton of qualified carbon oxide 
which is— 
‘‘(A) captured by the taxpayer using carbon 
capture equipment which is originally placed in 
service at a qualified facility before the date of 
the enactment of the Bipartisan Budget Act of 
2018, and 
‘‘(B)(i) used by the taxpayer as a tertiary 
injectant in a qualified enhanced oil or natural 
gas recovery project and disposed of by the tax-
payer in secure geological storage, or 
‘‘(ii) utilized by the taxpayer in a manner 
described in subsection (f)(5), 
‘‘(3) the applicable dollar amount (as determined 
under subsection (b)(1)) per metric ton of qualified 
carbon oxide which is— 
‘‘(A) captured by the taxpayer using carbon 
capture equipment which is originally placed in 
service at a qualified facility on or after the date 
of the enactment of the Bipartisan Budget Act of
241 
† HR 1892 EAS2 
2018, during the 12-year period beginning on the 
date the equipment was originally placed in 
service, and 
‘‘(B) disposed of by the taxpayer in secure 
geological storage and not used by the taxpayer 
as described in paragraph (4)(B), and 
‘‘(4) the applicable dollar amount (as determined 
under subsection (b)(1)) per metric ton of qualified 
carbon oxide which is— 
‘‘(A) captured by the taxpayer using carbon 
capture equipment which is originally placed in 
service at a qualified facility on or after the date 
of the enactment of the Bipartisan Budget Act of 
2018, during the 12-year period beginning on the 
date the equipment was originally placed in 
service, and 
‘‘(B)(i) used by the taxpayer as a tertiary 
injectant in a qualified enhanced oil or natural 
gas recovery project and disposed of by the tax-
payer in secure geological storage, or 
‘‘(ii) utilized by the taxpayer in a manner 
described in subsection (f)(5). 
‘‘(b) APPLICABLE
DOLLAR
AMOUNT; ADDITIONAL 
EQUIPMENT; ELECTION.— 
‘‘(1) APPLICABLE DOLLAR AMOUNT.—
242 
† HR 1892 EAS2 
‘‘(A) IN GENERAL.—The applicable dollar 
amount shall be an amount equal to— 
‘‘(i) for any taxable year beginning in 
a calendar year after 2016 and before 
2027— 
‘‘(I) for purposes of paragraph (3) 
of subsection (a), the dollar amount es-
tablished by linear interpolation be-
tween $22.66 and $50 for each cal-
endar year during such period, and 
‘‘(II) for purposes of paragraph 
(4) of such subsection, the dollar 
amount established by linear interpola-
tion between $12.83 and $35 for each 
calendar year during such period, and 
‘‘(ii) for any taxable year beginning in 
a calendar year after 2026— 
‘‘(I) for purposes of paragraph (3) 
of subsection (a), an amount equal to 
the product of $50 and the inflation 
adjustment factor for such calendar 
year 
determined 
under 
section 
43(b)(3)(B) for such calendar year, de-
termined by substituting ‘2025’ for 
‘1990’, and
243 
† HR 1892 EAS2 
‘‘(II) for purposes of paragraph 
(4) of such subsection, an amount 
equal to the product of $35 and the in-
flation adjustment factor for such cal-
endar year determined under section 
43(b)(3)(B) for such calendar year, de-
termined by substituting ‘2025’ for 
‘1990’. 
‘‘(B) ROUNDING.—The applicable dollar 
amount determined under subparagraph (A) 
shall be rounded to the nearest cent. 
‘‘(2) INSTALLATION OF ADDITIONAL CARBON CAP-
TURE
EQUIPMENT
ON
EXISTING
QUALIFIED
FACIL-
ITY.—In the case of a qualified facility placed in 
service before the date of the enactment of the Bipar-
tisan Budget Act of 2018, for which additional carbon 
capture equipment is placed in service on or after the 
date of the enactment of such Act, the amount of 
qualified carbon oxide which is captured by the tax-
payer shall be equal to— 
‘‘(A) for purposes of paragraphs (1)(A) and 
(2)(A) of subsection (a), the lesser of— 
‘‘(i) the total amount of qualified car-
bon oxide captured at such facility for the 
taxable year, or
244 
† HR 1892 EAS2 
‘‘(ii) the total amount of the carbon di-
oxide capture capacity of the carbon cap-
ture equipment in service at such facility on 
the day before the date of the enactment of 
the Bipartisan Budget Act of 2018, and 
‘‘(B) for purposes of paragraphs (3)(A) and 
(4)(A) of such subsection, an amount (not less 
than zero) equal to the excess of— 
‘‘(i) the amount described in clause (i) 
of subparagraph (A), over 
‘‘(ii) the amount described in clause 
(ii) of such subparagraph. 
‘‘(3) ELECTION.—For purposes of determining 
the carbon oxide sequestration credit under this sec-
tion, a taxpayer may elect to have the dollar amounts 
applicable under paragraph (1) or (2) of subsection 
(a) apply in lieu of the dollar amounts applicable 
under paragraph (3) or (4) of such subsection for each 
metric ton of qualified carbon oxide which is captured 
by the taxpayer using carbon capture equipment 
which is originally placed in service at a qualified fa-
cility on or after the date of the enactment of the Bi-
partisan Budget Act of 2018. 
‘‘(c) QUALIFIED CARBON OXIDE.—For purposes of this 
section—
245 
† HR 1892 EAS2 
‘‘(1) IN GENERAL.—The term ‘qualified carbon 
oxide’ means— 
‘‘(A) any carbon dioxide which— 
‘‘(i) is captured from an industrial 
source by carbon capture equipment which 
is originally placed in service before the 
date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) would otherwise be released into 
the atmosphere as industrial emission of 
greenhouse gas or lead to such release, and 
‘‘(iii) is measured at the source of cap-
ture and verified at the point of disposal, 
injection, or utilization, 
‘‘(B) any carbon dioxide or other carbon 
oxide which— 
‘‘(i) is captured from an industrial 
source by carbon capture equipment which 
is originally placed in service on or after 
the date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) would otherwise be released into 
the atmosphere as industrial emission of 
greenhouse gas or lead to such release, and
246 
† HR 1892 EAS2 
‘‘(iii) is measured at the source of cap-
ture and verified at the point of disposal, 
injection, or utilization, or 
‘‘(C) in the case of a direct air capture fa-
cility, any carbon dioxide which— 
‘‘(i) is captured directly from the am-
bient air, and 
‘‘(ii) is measured at the source of cap-
ture and verified at the point of disposal, 
injection, or utilization. 
‘‘(2) RECYCLED
CARBON
OXIDE.—The term 
‘qualified carbon oxide’ includes the initial deposit of 
captured carbon oxide used as a tertiary injectant. 
Such term does not include carbon oxide that is re-
captured, recycled, and re-injected as part of the en-
hanced oil and natural gas recovery process. 
‘‘(d) QUALIFIED FACILITY.—For purposes of this sec-
tion, the term ‘qualified facility’ means any industrial fa-
cility or direct air capture facility— 
‘‘(1) the construction of which begins before Jan-
uary 1, 2024, and— 
‘‘(A) construction of carbon capture equip-
ment begins before such date, or
247 
† HR 1892 EAS2 
‘‘(B) the original planning and design for 
such facility includes installation of carbon cap-
ture equipment, and 
‘‘(2) which captures— 
‘‘(A) in the case of a facility which emits 
not more than 500,000 metric tons of carbon 
oxide into the atmosphere during the taxable 
year, not less than 25,000 metric tons of quali-
fied carbon oxide during the taxable year which 
is utilized in a manner described in subsection 
(f)(5), 
‘‘(B) in the case of an electricity generating 
facility which is not described in subparagraph 
(A), not less than 500,000 metric tons of quali-
fied carbon oxide during the taxable year, or 
‘‘(C) in the case of a direct air capture fa-
cility or any facility not described in subpara-
graph (A) or (B), not less than 100,000 metric 
tons of qualified carbon oxide during the taxable 
year. 
‘‘(e) DEFINITIONS.—For purposes of this section— 
‘‘(1) DIRECT AIR CAPTURE FACILITY.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘direct air capture facility’ 
means any facility which uses carbon capture
248 
† HR 1892 EAS2 
equipment to capture carbon dioxide directly 
from the ambient air. 
‘‘(B) EXCEPTION.—The term ‘direct air 
capture facility’ shall not include any facility 
which captures carbon dioxide— 
‘‘(i) which is deliberately released from 
naturally occurring subsurface springs, or 
‘‘(ii) using natural photosynthesis. 
‘‘(2) QUALIFIED
ENHANCED
OIL
OR
NATURAL 
GAS
RECOVERY
PROJECT.—The term ‘qualified en-
hanced oil or natural gas recovery project’ has the 
meaning given the term ‘qualified enhanced oil recov-
ery project’ by section 43(c)(2), by substituting ‘crude 
oil or natural gas’ for ‘crude oil’ in subparagraph 
(A)(i) thereof. 
‘‘(3) TERTIARY INJECTANT.—The term ‘tertiary 
injectant’ has the same meaning as when used within 
section 193(b)(1). 
‘‘(f) SPECIAL RULES.— 
‘‘(1) ONLY QUALIFIED CARBON OXIDE CAPTURED 
AND
DISPOSED
OF
OR
USED
WITHIN
THE
UNITED 
STATES TAKEN INTO ACCOUNT.—The credit under this 
section shall apply only with respect to qualified car-
bon oxide the capture and disposal, use, or utilization 
of which is within—
249 
† HR 1892 EAS2 
‘‘(A) the United States (within the meaning 
of section 638(1)), or 
‘‘(B) a possession of the United States 
(within the meaning of section 638(2)). 
‘‘(2) SECURE GEOLOGICAL STORAGE.—The Sec-
retary, in consultation with the Administrator of the 
Environmental Protection Agency, the Secretary of 
Energy, and the Secretary of the Interior, shall estab-
lish regulations for determining adequate security 
measures for the geological storage of qualified carbon 
oxide under subsection (a) such that the qualified car-
bon oxide does not escape into the atmosphere. Such 
term shall include storage at deep saline formations, 
oil and gas reservoirs, and unminable coal seams 
under such conditions as the Secretary may deter-
mine under such regulations. 
‘‘(3) CREDIT ATTRIBUTABLE TO TAXPAYER.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B) or in any regulations pre-
scribed by the Secretary, any credit under this 
section shall be attributable to— 
‘‘(i) in the case of qualified carbon 
oxide captured using carbon capture equip-
ment which is originally placed in service 
at a qualified facility before the date of the
250 
† HR 1892 EAS2 
enactment of the Bipartisan Budget Act of 
2018, the person that captures and phys-
ically or contractually ensures the disposal, 
utilization, or use as a tertiary injectant of 
such qualified carbon oxide, and 
‘‘(ii) in the case of qualified carbon 
oxide captured using carbon capture equip-
ment which is originally placed in service 
at a qualified facility on or after the date 
of the enactment of the Bipartisan Budget 
Act of 2018, the person that owns the car-
bon capture equipment and physically or 
contractually ensures the capture and dis-
posal, utilization, or use as a tertiary 
injectant of such qualified carbon oxide. 
‘‘(B) ELECTION.—If the person described in 
subparagraph (A) makes an election under this 
subparagraph in such time and manner as the 
Secretary may prescribe by regulations, the cred-
it under this section— 
‘‘(i) shall be allowable to the person 
that disposes of the qualified carbon oxide, 
utilizes the qualified carbon oxide, or uses 
the qualified carbon oxide as a tertiary 
injectant, and
251 
† HR 1892 EAS2 
‘‘(ii) shall not be allowable to the per-
son described in subparagraph (A). 
‘‘(4) RECAPTURE.—The Secretary shall, by regu-
lations, provide for recapturing the benefit of any 
credit allowable under subsection (a) with respect to 
any qualified carbon oxide which ceases to be cap-
tured, disposed of, or used as a tertiary injectant in 
a manner consistent with the requirements of this sec-
tion. 
‘‘(5) 
UTILIZATION
OF
QUALIFIED
CARBON 
OXIDE.— 
‘‘(A) IN
GENERAL.—For purposes of this 
section, utilization of qualified carbon oxide 
means— 
‘‘(i) the fixation of such qualified car-
bon 
oxide 
through 
photosynthesis 
or 
chemosynthesis, such as through the growing 
of algae or bacteria, 
‘‘(ii) the chemical conversion of such 
qualified carbon oxide to a material or 
chemical compound in which such qualified 
carbon oxide is securely stored, or 
‘‘(iii) the use of such qualified carbon 
oxide for any other purpose for which a 
commercial market exists (with the excep-
252 
† HR 1892 EAS2 
tion of use as a tertiary injectant in a 
qualified enhanced oil or natural gas recov-
ery project), as determined by the Secretary. 
‘‘(B) MEASUREMENT.— 
‘‘(i) IN GENERAL.—For purposes of de-
termining the amount of qualified carbon 
oxide utilized by the taxpayer under para-
graph (2)(B)(ii) or (4)(B)(ii) of subsection 
(a), such amount shall be equal to the met-
ric tons of qualified carbon oxide which the 
taxpayer demonstrates, based upon an anal-
ysis of lifecycle greenhouse gas emissions 
and subject to such requirements as the Sec-
retary, in consultation with the Secretary of 
Energy and the Administrator of the Envi-
ronmental Protection Agency, determines 
appropriate, were— 
‘‘(I) captured and permanently 
isolated from the atmosphere, or 
‘‘(II) displaced from being emitted 
into the atmosphere, 
through use of a process described in sub-
paragraph (A). 
‘‘(ii) LIFECYCLE
GREENHOUSE
GAS 
EMISSIONS.—For purposes of clause (i), the
253 
† HR 1892 EAS2 
term ‘lifecycle greenhouse gas emissions’ has 
the same meaning given such term under 
subparagraph (H) of section 211(o)(1) of 
the Clean Air Act (42 U.S.C. 7545(o)(1)), 
as in effect on the date of the enactment of 
the Bipartisan Budget Act of 2018, except 
that ‘product’ shall be substituted for ‘fuel’ 
each place it appears in such subparagraph. 
‘‘(6) ELECTION FOR APPLICABLE FACILITIES.— 
‘‘(A) IN
GENERAL.—For purposes of this 
section, in the case of an applicable facility, for 
any taxable year in which such facility captures 
not less than 500,000 metric tons of qualified 
carbon oxide during the taxable year, the person 
described in paragraph (3)(A)(ii) may elect to 
have such facility, and any carbon capture 
equipment placed in service at such facility, 
deemed as having been placed in service on the 
date of the enactment of the Bipartisan Budget 
Act of 2018. 
‘‘(B) APPLICABLE FACILITY.—For purposes 
of this paragraph, the term ‘applicable facility’ 
means a qualified facility—
254 
† HR 1892 EAS2 
‘‘(i) which was placed in service before 
the date of the enactment of the Bipartisan 
Budget Act of 2018, and 
‘‘(ii) for which no taxpayer claimed a 
credit under this section in regards to such 
facility for any taxable year ending before 
the date of the enactment of such Act. 
‘‘(7) INFLATION
ADJUSTMENT.—In the case of 
any taxable year beginning in a calendar year after 
2009, there shall be substituted for each dollar amount 
contained in paragraphs (1) and (2) of subsection (a) 
an amount equal to the product of— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the inflation adjustment factor for 
such calendar year determined under section 
43(b)(3)(B) for such calendar year, determined 
by substituting ‘2008’ for ‘1990’. 
‘‘(g) APPLICATION OF SECTION FOR CERTAIN CARBON 
CAPTURE EQUIPMENT.—In the case of any carbon capture 
equipment placed in service before the date of the enactment 
of the Bipartisan Budget Act of 2018, the credit under this 
section shall apply with respect to qualified carbon oxide 
captured using such equipment before the end of the cal-
endar year in which the Secretary, in consultation with the 
Administrator of the Environmental Protection Agency,
255 
† HR 1892 EAS2 
certifies that, during the period beginning after October 3, 
2008, a total of 75,000,000 metric tons of qualified carbon 
oxide have been taken into account in accordance with— 
‘‘(1) subsection (a) of this section, as in effect on 
the day before the date of the enactment of the Bipar-
tisan Budget Act of 2018, and 
‘‘(2) paragraphs (1) and (2) of subsection (a) of 
this section. 
‘‘(h) REGULATIONS.—The Secretary may prescribe 
such regulations and other guidance as may be necessary 
or appropriate to carry out this section, including regula-
tions or other guidance to— 
‘‘(1) ensure proper allocation under subsection 
(a) for qualified carbon oxide captured by a taxpayer 
during the taxable year ending after the date of the 
enactment of the Bipartisan Budget Act of 2018, and 
‘‘(2) determine whether a facility satisfies the re-
quirements under subsection (d)(1) during such tax-
able year.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to taxable years beginning after Decem-
ber 31, 2017.
256 
† HR 1892 EAS2 
DIVISION E—HEALTH AND 
HUMAN SERVICES EXTENDERS 
SEC. 50100. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This division may be cited as the 
‘‘Advancing Chronic Care, Extenders, and Social Services 
(ACCESS) Act’’ 
(b) TABLE OF CONTENTS.—The table of contents for 
this division is as follows: 
DIVISION E—HEALTH AND HUMAN SERVICES EXTENDERS 
Sec. 50100. Short title; table of contents. 
TITLE I—CHIP 
Sec. 50101. Funding extension of the Children’s Health Insurance Program 
through fiscal year 2027. 
Sec. 50102. Extension of pediatric quality measures program. 
Sec. 50103. Extension of outreach and enrollment program. 
TITLE II—MEDICARE EXTENDERS 
Sec. 50201. Extension of work GPCI floor. 
Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to 
ensure appropriate therapy. 
Sec. 50203. Medicare ambulance services. 
Sec. 50204. Extension of increased inpatient hospital payment adjustment for 
certain low-volume hospitals. 
Sec. 50205. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 50206. Extension of funding for quality measure endorsement, input, and se-
lection; reporting requirements. 
Sec. 50207. Extension of funding outreach and assistance for low-income pro-
grams; State health insurance assistance program reporting re-
quirements. 
Sec. 50208. Extension of home health rural add-on. 
TITLE III—CREATING HIGH-QUALITY RESULTS AND OUTCOMES 
NECESSARY TO IMPROVE CHRONIC (CHRONIC) CARE 
Subtitle A—Receiving High Quality Care in the Home 
Sec. 50301. Extending the Independence at Home Demonstration Program. 
Sec. 50302. Expanding access to home dialysis therapy. 
Subtitle B—Advancing Team-Based Care 
Sec. 50311. Providing continued access to Medicare Advantage special needs 
plans for vulnerable populations.
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Subtitle C—Expanding Innovation and Technology 
Sec. 50321. Adapting benefits to meet the needs of chronically ill Medicare Ad-
vantage enrollees. 
Sec. 50322. Expanding supplemental benefits to meet the needs of chronically ill 
Medicare Advantage enrollees. 
Sec. 50323. Increasing convenience for Medicare Advantage enrollees through tele-
health. 
Sec. 50324. Providing accountable care organizations the ability to expand the 
use of telehealth. 
Sec. 50325. Expanding the use of telehealth for individuals with stroke. 
Subtitle D—Identifying the Chronically Ill Population 
Sec. 50331. Providing flexibility for beneficiaries to be part of an accountable 
care organization. 
Subtitle E—Empowering Individuals and Caregivers in Care Delivery 
Sec. 50341. Eliminating barriers to care coordination under accountable care or-
ganizations. 
Sec. 50342. GAO study and report on longitudinal comprehensive care planning 
services under Medicare part B. 
Subtitle F—Other Policies to Improve Care for the Chronically Ill 
Sec. 50351. GAO study and report on improving medication synchronization. 
Sec. 50352. GAO study and report on impact of obesity drugs on patient health 
and spending. 
Sec. 50353. HHS study and report on long-term risk factors for chronic condi-
tions among Medicare beneficiaries. 
Sec. 50354. Providing prescription drug plans with parts A and B claims data 
to promote the appropriate use of medications and improve 
health outcomes. 
TITLE IV—PART B IMPROVEMENT ACT AND OTHER PART B 
ENHANCEMENTS 
Subtitle A—Medicare Part B Improvement Act 
Sec. 50401. Home infusion therapy services temporary transitional payment. 
Sec. 50402. Orthotist’s and prosthetist’s clinical notes as part of the patient’s 
medical record. 
Sec. 50403. Independent accreditation for dialysis facilities and assurance of high 
quality surveys. 
Sec. 50404. Modernizing the application of the Stark rule under Medicare. 
Subtitle B—Additional Medicare Provisions 
Sec. 50411. Making permanent the removal of the rental cap for durable medical 
equipment under Medicare with respect to speech generating de-
vices. 
Sec. 50412. Increased civil and criminal penalties and increased sentences for 
Federal health care program fraud and abuse. 
Sec. 50413. Reducing the volume of future EHR-related significant hardship re-
quests. 
Sec. 50414. Strengthening rules in case of competition for diabetic testing strips.
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TITLE V—OTHER HEALTH EXTENDERS 
Sec. 50501. Extension for family-to-family health information centers. 
Sec. 50502. Extension for sexual risk avoidance education. 
Sec. 50503. Extension for personal responsibility education. 
TITLE VI—CHILD AND FAMILY SERVICES AND SUPPORTS 
EXTENDERS 
Subtitle A—Continuing the Maternal, Infant, and Early Childhood Home 
Visiting Program 
Sec. 50601. Continuing evidence-based home visiting program. 
Sec. 50602. Continuing to demonstrate results to help families. 
Sec. 50603. Reviewing statewide needs to target resources. 
Sec. 50604. Improving the likelihood of success in high-risk communities. 
Sec. 50605. Option to fund evidence-based home visiting on a pay for outcome 
basis. 
Sec. 50606. Data exchange standards for improved interoperability. 
Sec. 50607. Allocation of funds. 
Subtitle B—Extension of Health Professions Workforce Demonstration Projects 
Sec. 50611. Extension of health workforce demonstration projects for low-income 
individuals. 
TITLE VII—FAMILY FIRST PREVENTION SERVICES ACT 
Subtitle A—Investing in Prevention and Supporting Families 
Sec. 50701. Short title. 
Sec. 50702. Purpose. 
PART I—PREVENTION ACTIVITIES UNDER TITLE IV–E 
Sec. 50711. Foster care prevention services and programs. 
Sec. 50712. Foster care maintenance payments for children with parents in a li-
censed residential family-based treatment facility for substance 
abuse. 
Sec. 50713. Title IV–E payments for evidence-based kinship navigator programs. 
PART II—ENHANCED SUPPORT UNDER TITLE IV–B 
Sec. 50721. Elimination of time limit for family reunification services while in 
foster care and permitting time-limited family reunification 
services when a child returns home from foster care. 
Sec. 50722. Reducing bureaucracy and unnecessary delays when placing children 
in homes across State lines. 
Sec. 50723. Enhancements to grants to improve well-being of families affected by 
substance abuse. 
PART III—MISCELLANEOUS 
Sec. 50731. Reviewing and improving licensing standards for placement in a rel-
ative foster family home. 
Sec. 50732. Development of a statewide plan to prevent child abuse and neglect 
fatalities. 
Sec. 50733. Modernizing the title and purpose of title IV–E. 
Sec. 50734. Effective dates.
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PART IV—ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A 
FOSTER FAMILY HOME 
Sec. 50741. Limitation on Federal financial participation for placements that 
are not in foster family homes. 
Sec. 50742. Assessment and documentation of the need for placement in a quali-
fied residential treatment program. 
Sec. 50743. Protocols to prevent inappropriate diagnoses. 
Sec. 50744. Additional data and reports regarding children placed in a setting 
that is not a foster family home. 
Sec. 50745. Criminal records checks and checks of child abuse and neglect reg-
istries for adults working in child-care institutions and other 
group care settings. 
Sec. 50746. Effective dates; application to waivers. 
PART V—CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES 
Sec. 50751. Supporting and retaining foster families for children. 
Sec. 50752. Extension of child and family services programs. 
Sec. 50753. Improvements to the John H. Chafee foster care independence pro-
gram and related provisions. 
PART VI—CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND 
LEGAL GUARDIANSHIP 
Sec. 50761. Reauthorizing adoption and legal guardianship incentive programs. 
PART VII—TECHNICAL CORRECTIONS 
Sec. 50771. Technical corrections to data exchange standards to improve program 
coordination. 
Sec. 50772. Technical corrections to State requirement to address the develop-
mental needs of young children. 
PART VIII—ENSURING STATES REINVEST SAVINGS RESULTING FROM 
INCREASE IN ADOPTION ASSISTANCE 
Sec. 50781. Delay of adoption assistance phase-in. 
Sec. 50782. GAO study and report on State reinvestment of savings resulting 
from increase in adoption assistance. 
TITLE VIII—SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY 
FOR RESULTS 
Sec. 50801. Short title. 
Sec. 50802. Social impact partnerships to pay for results. 
TITLE IX—PUBLIC HEALTH PROGRAMS 
Sec. 50901. Extension for community health centers, the National Health Service 
Corps, and teaching health centers that operate GME programs. 
Sec. 50902. Extension for special diabetes programs. 
TITLE X—MISCELLANEOUS HEALTH CARE POLICIES 
Sec. 51001. Home health payment reform. 
Sec. 51002. Information to satisfy documentation of Medicare eligibility for home 
health services. 
Sec. 51003. Technical amendments to Public Law 114–10.
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Sec. 51004. Expanded access to Medicare intensive cardiac rehabilitation pro-
grams. 
Sec. 51005. Extension of blended site neutral payment rate for certain long-term 
care hospital discharges; temporary adjustment to site neutral 
payment rates. 
Sec. 51006. Recognition of attending physician assistants as attending physicians 
to serve hospice patients. 
Sec. 51007. Extension of enforcement instruction on supervision requirements for 
outpatient therapeutic services in critical access and small rural 
hospitals through 2017. 
Sec. 51008. Allowing physician assistants, nurse practitioners, and clinical nurse 
specialists to supervise cardiac, intensive cardiac, and pul-
monary rehabilitation programs. 
Sec. 51009. Transitional payment rules for certain radiation therapy services 
under the physician fee schedule. 
TITLE XI—PROTECTING SENIORS’ ACCESS TO MEDICARE ACT 
Sec. 52001. Repeal of the Independent Payment Advisory Board. 
TITLE XII—OFFSETS 
Sec. 53101. Modifying reductions in Medicaid DSH allotments. 
Sec. 53102. Third party liability in Medicaid and CHIP. 
Sec. 53103. Treatment of lottery winnings and other lump-sum income for pur-
poses of income eligibility under Medicaid. 
Sec. 53104. Rebate obligation with respect to line extension drugs. 
Sec. 53105. Medicaid Improvement Fund. 
Sec. 53106. Physician fee schedule update. 
Sec. 53107. Payment for outpatient physical therapy services and outpatient oc-
cupational therapy services furnished by a therapy assistant. 
Sec. 53108. Reduction for non-emergency ESRD ambulance transports. 
Sec. 53109. Hospital transfer policy for early discharges to hospice care. 
Sec. 53110. Medicare payment update for home health services. 
Sec. 53111. Medicare payment update for skilled nursing facilities. 
Sec. 53112. Preventing the artificial inflation of star ratings after the consolida-
tion of Medicare Advantage plans offered by the same organiza-
tion. 
Sec. 53113. Sunsetting exclusion of biosimilars from Medicare part D coverage 
gap discount program. 
Sec. 53114. Adjustments to Medicare part B and part D premium subsidies for 
higher income individuals. 
Sec. 53115. Medicare Improvement Fund. 
Sec. 53116. Closing the Donut Hole for Seniors. 
Sec. 53117. Modernizing child support enforcement fees. 
Sec. 53118. Increasing efficiency of prison data reporting. 
Sec. 53119. Prevention and Public Health Fund.
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TITLE I—CHIP 
SEC. 50101. FUNDING EXTENSION OF THE CHILDREN’S 
HEALTH INSURANCE PROGRAM THROUGH 
FISCAL YEAR 2027. 
(a) IN GENERAL.—Section 2104(a) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)), as amended by section 
3002(a) of the HEALTHY KIDS Act (division C of Public 
Law 115–120), is amended— 
(1) in paragraph (25), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) in paragraph (26), by striking the period at 
the end and inserting a semicolon; and 
(3) by adding at the end the following new para-
graphs: 
‘‘(27) for each of fiscal years 2024 through 2026, 
such sums as are necessary to fund allotments to 
States under subsections (c) and (m); and 
‘‘(28) for fiscal year 2027, for purposes of mak-
ing two semi-annual allotments— 
‘‘(A) $7,650,000,000 for the period begin-
ning on October 1, 2026, and ending on March 
31, 2027; and 
‘‘(B) $7,650,000,000 for the period begin-
ning on April 1, 2027, and ending on September 
30, 2027.’’.
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(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the Social 
Security Act (42 U.S.C. 1397dd(m)), as amended by 
section 3002(b) of the HEALTHY KIDS Act (division 
C of Public Law 115–120), is amended— 
(A) in paragraph (2)(B)— 
(i) in the matter preceding clause (i), 
by striking ‘‘(25)’’ and inserting ‘‘(27)’’; 
(ii) in clause (i), by striking ‘‘and 
2023’’ and inserting ‘‘, 2023, and 2027’’; 
and 
(iii) in clause (ii)(I), by striking ‘‘(or, 
in the case of fiscal year 2018, under para-
graph (4))’’ and inserting ‘‘(or, in the case 
of fiscal year 2018 or 2024, under para-
graph (4) or (10), respectively)’’; 
(B) in paragraph (5)— 
(i) by striking ‘‘or (10)’’ and inserting 
‘‘(10), or (11)’’; and 
(ii) by striking ‘‘or 2023,’’ and insert-
ing ‘‘2023, or 2027,’’; 
(C) in paragraph (7)— 
(i) in subparagraph (A), by striking 
‘‘2023’’ and inserting ‘‘2027,’’; and
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(ii) in the matter following subpara-
graph (B), by striking ‘‘or fiscal year 2022’’ 
and inserting ‘‘fiscal year 2022, fiscal year 
2024, or fiscal year 2026’’; 
(D) in paragraph (9)— 
(i) by striking ‘‘or (10)’’ and inserting 
‘‘(10), or (11)’’; and 
(ii) by striking ‘‘or 2023,’’ and insert-
ing ‘‘2023, or 2027,’’; and 
(E) by adding at the end the following: 
‘‘(11) FOR FISCAL YEAR 2027.— 
‘‘(A) FIRST HALF.—Subject to paragraphs 
(5) and (7), from the amount made available 
under subparagraph (A) of paragraph (28) of 
subsection (a) for the semi-annual period de-
scribed in such subparagraph, increased by the 
amount of the appropriation for such period 
under section 50101(b)(2) of the Advancing 
Chronic Care, Extenders, and Social Services 
Act, the Secretary shall compute a State allot-
ment for each State (including the District of 
Columbia and each commonwealth and territory) 
for such semi-annual period in an amount equal 
to the first half ratio (described in subparagraph
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(D)) of the amount described in subparagraph 
(C). 
‘‘(B) SECOND
HALF.—Subject to para-
graphs (5) and (7), from the amount made 
available under subparagraph (B) of paragraph 
(28) of subsection (a) for the semi-annual period 
described in such subparagraph, the Secretary 
shall compute a State allotment for each State 
(including the District of Columbia and each 
commonwealth and territory) for such semi-an-
nual period in an amount equal to the amount 
made available under such subparagraph, multi-
plied by the ratio of— 
‘‘(i) the amount of the allotment to 
such State under subparagraph (A); to 
‘‘(ii) the total of the amount of all of 
the allotments made available under such 
subparagraph. 
‘‘(C) FULL
YEAR
AMOUNT
BASED
ON 
REBASED
AMOUNT.—The amount described in 
this subparagraph for a State is equal to the 
Federal payments to the State that are attrib-
utable to (and countable towards) the total 
amount of allotments available under this section 
to the State in fiscal year 2026 (including pay-
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† HR 1892 EAS2 
ments made to the State under subsection (n) for 
fiscal year 2026 as well as amounts redistributed 
to the State in fiscal year 2026), multiplied by 
the allotment increase factor under paragraph 
(6) for fiscal year 2027. 
‘‘(D) FIRST
HALF
RATIO.—The first half 
ratio described in this subparagraph is the ratio 
of— 
‘‘(i) the sum of— 
‘‘(I) the amount made available 
under subsection (a)(28)(A); and 
‘‘(II) the amount of the appro-
priation for such period under section 
50101(b)(2) of the Advancing Chronic 
Care, Extenders, and Social Services 
Act; to 
‘‘(ii) the sum of— 
‘‘(I) the amount described in 
clause (i); and 
‘‘(II) the amount made available 
under subsection (a)(28)(B).’’. 
(2) ONE-TIME APPROPRIATION FOR FISCAL YEAR 
2027.—There is appropriated to the Secretary of 
Health and Human Services, out of any money in the 
Treasury not otherwise appropriated, such sums as
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† HR 1892 EAS2 
are necessary to fund allotments to States under sub-
sections (c) and (m) of section 2104 of the Social Se-
curity Act (42 U.S.C. 1397dd) for fiscal year 2027, 
taking into account the full year amounts calculated 
for States under paragraph (11)(C) of subsection (m) 
of such section (as added by paragraph (1)) and the 
amounts appropriated under subparagraphs (A) and 
(B) of subsection (a)(28) of such section (as added by 
subsection (a)). Such amount shall accompany the al-
lotment made for the period beginning on October 1, 
2026, and ending on March 31, 2027, under para-
graph (28)(A) of section 2104(a) of such Act (42 
U.S.C. 1397dd(a)), to remain available until ex-
pended. Such amount shall be used to provide allot-
ments to States under paragraph (11) of section 
2104(m) of such Act for the first 6 months of fiscal 
year 2027 in the same manner as allotments are pro-
vided under subsection (a)(28)(A) of such section 
2104 and subject to the same terms and conditions as 
apply to the allotments provided from such subsection 
(a)(28)(A). 
(c) EXTENSION OF THE CHILD ENROLLMENT CONTIN-
GENCY FUND.—Section 2104(n) of the Social Security Act 
(42 U.S.C. 1397dd(n)), as amended by section 3002(c) of
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† HR 1892 EAS2 
the HEALTHY KIDS Act (division C of Public Law 115– 
120), is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘and 2018 through 
2022’’ and inserting ‘‘2018 through 2022, 
and 2024 through 2026’’; and 
(ii) by striking ‘‘and 2023’’ and insert-
ing ‘‘2023, and 2027’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘and 2018 through 
2022’’ and inserting ‘‘2018 through 2022, 
and 2024 through 2026’’; and 
(ii) by striking ‘‘and 2023’’ and insert-
ing ‘‘2023, and 2027’’; and 
(2) in paragraph (3)(A), in the matter preceding 
clause (i)— 
(A) by striking ‘‘or in any of fiscal years 
2018 through 2022’’ and inserting ‘‘fiscal years 
2018 through 2022, or fiscal years 2024 through 
2026’’; and 
(B) by striking ‘‘or 2023’’ and inserting 
‘‘2023, or 2027’’. 
(d) EXTENSION OF QUALIFYING STATES OPTION.— 
Section 2105(g)(4) of the Social Security Act (42 U.S.C.
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† HR 1892 EAS2 
1397ee(g)(4)), as amended by section 3002(d) of the 
HEALTHY KIDS Act (division C of Public Law 115–120), 
is amended— 
(1) in the paragraph heading, by striking 
‘‘THROUGH 2023’’ and inserting ‘‘THROUGH 2027’’; 
and 
(2) in subparagraph (A), by striking ‘‘2023’’ and 
inserting ‘‘2027’’. 
(e) EXTENSION OF EXPRESS LANE ELIGIBILITY OP-
TION.—Section 1902(e)(13)(I) of the Social Security Act 
(42 U.S.C. 1396a(e)(13)(I)), as amended by section 3002(e) 
of the HEALTHY KIDS Act (division C of Public Law 
115–120), is amended by striking ‘‘2023’’ and inserting 
‘‘2027’’. 
(f) ASSURANCE OF ELIGIBILITY STANDARD FOR CHIL-
DREN AND FAMILIES.— 
(1) IN GENERAL.—Section 2105(d)(3) of the So-
cial Security Act (42 U.S.C. 1397ee(d)(3)), as amend-
ed by section 3002(f)(1) of the HEALTHY KIDS Act 
(division C of Public Law 115–120), is amended— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2023’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2027’’; and
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† HR 1892 EAS2 
(B) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘2023’’ each place 
it appears and inserting ‘‘2027’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1902(gg)(2) of the Social Security Act (42 U.S.C. 
1396a(gg)(2)), as amended by section 3002(f)(2) of 
the HEALTHY KIDS Act (division C of Public Law 
115–120), is amended— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2023’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(B) by striking ‘‘2023,’’ each place it ap-
pears and inserting ‘‘2027’’. 
SEC. 50102. EXTENSION OF PEDIATRIC QUALITY MEASURES 
PROGRAM. 
(a) IN GENERAL.—Section 1139A(i)(1) of the Social 
Security Act (42 U.S.C. 1320b–9a(i)(1)), as amended by 
section 3003(b) of the HEALTHY KIDS Act (division C 
of Public Law 115–120), is amended— 
(1) in subparagraph (B), by striking ‘‘; and’’ 
and inserting a semicolon; 
(2) in subparagraph (C), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph:
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† HR 1892 EAS2 
‘‘(D) for the period of fiscal years 2024 
through 2027, $60,000,000 for the purpose of 
carrying out this section (other than subsections 
(e), (f), and (g)).’’. 
(b) MAKING REPORTING MANDATORY.—Section 1139A 
of the Social Security Act (42 U.S.C. 1320b–9a) is amend-
ed— 
(1) in subsection (a)— 
(A) in the heading for paragraph (4), by 
inserting ‘‘AND
MANDATORY
REPORTING’’ after 
‘‘REPORTING’’; 
(B) in paragraph (4)— 
(i) by striking ‘‘Not later than’’ and 
inserting the following: 
‘‘(A) VOLUNTARY
REPORTING.—Not later 
than’’; and 
(ii) by adding at the end the following: 
‘‘(B) MANDATORY REPORTING.—Beginning 
with the annual State report on fiscal year 2024 
required under subsection (c)(1), the Secretary 
shall require States to use the initial core meas-
urement set and any updates or changes to that 
set to report information regarding the quality of 
pediatric health care under titles XIX and XXI 
using the standardized format for reporting in-
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† HR 1892 EAS2 
formation and procedures developed under sub-
paragraph (A).’’; and 
(C) in paragraph (6)(B), by inserting ‘‘and, 
beginning with the report required on January 
1, 2025, and for each annual report thereafter, 
the status of mandatory reporting by States 
under titles XIX and XXI, utilizing the initial 
core quality measurement set and any updates 
or changes to that set’’ before the semicolon; and 
(2) in subsection (c)(1)(A), by inserting ‘‘and, 
beginning with the annual report on fiscal year 2024, 
all of the core measures described in subsection (a) 
and any updates or changes to those measures’’ before 
the semicolon. 
SEC. 50103. EXTENSION OF OUTREACH AND ENROLLMENT 
PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Security 
Act (42 U.S.C. 1397mm), as amended by section 3004(a) 
of the HEALTHY KIDS Act (division C of Public Law 
115–120), is amended— 
(1) in subsection (a)(1), by striking ‘‘2023’’ and 
inserting ‘‘2027’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $120,000,000’’ and in-
serting ‘‘, $120,000,000’’; and
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† HR 1892 EAS2 
(B) by inserting ‘‘, and $48,000,000 for the 
period of fiscal years 2024 through 2027’’ after 
‘‘2023’’. 
(b) ADDITIONAL RESERVED FUNDS.—Section 2113(a) 
of the Social Security Act (42 U.S.C. 1397mm(a)) is 
amended— 
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (3)’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(3) TEN PERCENT SET ASIDE FOR EVALUATING 
AND PROVIDING TECHNICAL ASSISTANCE TO GRANT-
EES.—For the period of fiscal years 2024 through 
2027, an amount equal to 10 percent of such amounts 
shall be used by the Secretary for the purpose of eval-
uating and providing technical assistance to eligible 
entities awarded grants under this section.’’. 
(c) USE OF RESERVED FUNDS FOR NATIONAL EN-
ROLLMENT AND RETENTION STRATEGIES.—Section 2113(h) 
of the Social Security Act (42 U.S.C. 1397mm(h)) is 
amended— 
(1) in paragraph (5), by striking ‘‘; and’’ and 
inserting a semicolon; 
(2) by redesignating paragraph (6) as para-
graph (7); and
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† HR 1892 EAS2 
(3) by inserting after paragraph (5) the fol-
lowing new paragraph: 
‘‘(6) the development of materials and toolkits 
and the provision of technical assistance to States re-
garding enrollment and retention strategies for eligi-
ble children under this title and title XIX; and’’. 
TITLE II—MEDICARE 
EXTENDERS 
SEC. 50201. EXTENSION OF WORK GPCI FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 1, 2018’’ and inserting ‘‘January 1, 2020’’. 
SEC. 50202. REPEAL OF MEDICARE PAYMENT CAP FOR 
THERAPY SERVICES; LIMITATION TO ENSURE 
APPROPRIATE THERAPY. 
Section 1833(g) of the Social Security Act (42 U.S.C. 
1395l(g)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘Subject to paragraphs (4) 
and (5)’’ and inserting ‘‘(A) Subject to para-
graphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted 
and designated by subparagraph (A) of this 
paragraph, by adding at the end the following 
new sentence: ‘‘The preceding sentence shall not
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† HR 1892 EAS2 
apply to expenses incurred with respect to serv-
ices furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(B) With respect to services furnished during 2018 
or a subsequent year, in the case of physical therapy serv-
ices of the type described in section 1861(p), speech-lan-
guage pathology services of the type described in such sec-
tion through the application of section 1861(ll)(2), and 
physical therapy services and speech-language pathology 
services of such type which are furnished by a physician 
or as incident to physicians’ services, with respect to ex-
penses incurred in any calendar year, any amount that is 
more than the amount specified in paragraph (2) for the 
year shall not be considered as incurred expenses for pur-
poses of subsections (a) and (b) unless the applicable re-
quirements of paragraph (7) are met.’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘Subject to paragraphs (4) 
and (5)’’ and inserting ‘‘(A) Subject to para-
graphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted 
and designated by subparagraph (A) of this 
paragraph, by adding at the end the following 
new sentence: ‘‘The preceding sentence shall not
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† HR 1892 EAS2 
apply to expenses incurred with respect to serv-
ices furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new 
subparagraph:. 
‘‘(B) With respect to services furnished during 2018 
or a subsequent year, in the case of occupational therapy 
services (of the type that are described in section 1861(p) 
through the operation of section 1861(g) and of such type 
which are furnished by a physician or as incident to physi-
cians’ services), with respect to expenses incurred in any 
calendar year, any amount that is more than the amount 
specified in paragraph (2) for the year shall not be consid-
ered as incurred expenses for purposes of subsections (a) 
and (b) unless the applicable requirements of paragraph (7) 
are met.’’; 
(3) in paragraph (5)— 
(A) by redesignating subparagraph (D) as 
paragraph (8) and moving such paragraph to 
immediately follow paragraph (7), as added by 
paragraph (4) of this section; and 
(B) in subparagraph (E)(iv), by inserting 
‘‘, except as such process is applied under para-
graph (7)(B)’’ before the period at the end; and 
(4) by adding at the end the following new para-
graph:
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† HR 1892 EAS2 
‘‘(7) For purposes of paragraphs (1)(B) and (3)(B), 
with respect to services described in such paragraphs, the 
requirements described in this paragraph are as follows: 
‘‘(A) INCLUSION OF APPROPRIATE MODIFIER.— 
The claim for such services contains an appropriate 
modifier (such as the KX modifier described in para-
graph (5)(B)) indicating that such services are medi-
cally necessary as justified by appropriate docu-
mentation in the medical record involved. 
‘‘(B) TARGETED MEDICAL REVIEW FOR CERTAIN 
SERVICES ABOVE THRESHOLD.— 
‘‘(i) IN GENERAL.—In the case where ex-
penses that would be incurred for such services 
would exceed the threshold described in clause 
(ii) for the year, such services shall be subject to 
the process for medical review implemented 
under paragraph (5)(E). 
‘‘(ii) THRESHOLD.—The threshold under 
this clause for— 
‘‘(I) a year before 2028, is $3,000; 
‘‘(II) 2028, is the amount specified in 
subclause (I) increased by the percentage in-
crease in the MEI (as defined in section 
1842(i)(3)) for 2028; and
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† HR 1892 EAS2 
‘‘(III) a subsequent year, is the amount 
specified in this clause for the preceding 
year increased by the percentage increase in 
the MEI (as defined in section 1842(i)(3)) 
for such subsequent year; 
except that if an increase under subclause (II) or 
(III) for a year is not a multiple of $10, it shall 
be rounded to the nearest multiple of $10. 
‘‘(iii) APPLICATION.—The threshold under 
clause (ii) shall be applied separately— 
‘‘(I) for physical therapy services and 
speech-language pathology services; and 
‘‘(II) for occupational therapy services. 
‘‘(iv) FUNDING.—For purposes of carrying 
out this subparagraph, the Secretary shall pro-
vide for the transfer, from the Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841 to the Centers for Medicare & Med-
icaid Services Program Management Account, of 
$5,000,000 for each fiscal year beginning with 
fiscal year 2018, to remain available until ex-
pended. Such funds may not be used by a con-
tractor under section 1893(h) for medical reviews 
under this subparagraph.’’.
278 
† HR 1892 EAS2 
SEC. 50203. MEDICARE AMBULANCE SERVICES. 
(a) EXTENSION
OF CERTAIN GROUND AMBULANCE 
ADD-ON PAYMENTS.— 
(1) 
GROUND
AMBULANCE.—Section 
1834(l)(13)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(13)(A)) is amended by striking ‘‘2018’’ and 
inserting ‘‘2023’’ each place it appears. 
(2) 
SUPER
RURAL
AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C. 
1395m(l)(12)(A)) is amended, in the first sentence, by 
striking ‘‘2018’’ and inserting ‘‘2023’’. 
(b) REQUIRING GROUND AMBULANCE PROVIDERS OF 
SERVICES AND SUPPLIERS TO SUBMIT COST AND OTHER 
INFORMATION.—Section 1834(l) of the Social Security Act 
(42 U.S.C. 1395m(l)) is amended by adding at the end the 
following new paragraph: 
‘‘(17) SUBMISSION OF COST AND OTHER INFOR-
MATION.— 
‘‘(A) DEVELOPMENT OF DATA COLLECTION 
SYSTEM.—The Secretary shall develop a data 
collection system (which may include use of a 
cost survey) to collect cost, revenue, utilization, 
and other information determined appropriate 
by the Secretary with respect to providers of 
services (in this paragraph referred to as ‘pro-
viders’) and suppliers of ground ambulance serv-
279 
† HR 1892 EAS2 
ices. Such system shall be designed to collect in-
formation— 
‘‘(i) needed to evaluate the extent to 
which reported costs relate to payment rates 
under this subsection; 
‘‘(ii) on the utilization of capital 
equipment and ambulance capacity, includ-
ing information consistent with the type of 
information described in section 1121(a); 
and 
‘‘(iii) on different types of ground am-
bulance services furnished in different geo-
graphic locations, including rural areas 
and low population density areas described 
in paragraph (12). 
‘‘(B) SPECIFICATION OF DATA COLLECTION 
SYSTEM.— 
‘‘(i) 
IN
GENERAL.—The 
Secretary 
shall— 
‘‘(I) not later than December 31, 
2019, specify the data collection system 
under subparagraph (A); and 
‘‘(II) identify the providers and 
suppliers of ground ambulance services 
that would be required to submit infor-
280 
† HR 1892 EAS2 
mation under such data collection sys-
tem, including the representative sam-
ple described in clause (ii). 
‘‘(ii) DETERMINATION OF REPRESENT-
ATIVE SAMPLE.— 
‘‘(I) IN GENERAL.—Not later than 
December 31, 2019, with respect to the 
data collection for the first year under 
such system, and for each subsequent 
year through 2024, the Secretary shall 
determine a representative sample to 
submit information under the data col-
lection system. 
‘‘(II) REQUIREMENTS.—The sam-
ple under subclause (I) shall be rep-
resentative of the different types of pro-
viders and suppliers of ground ambu-
lance services (such as those providers 
and suppliers that are part of an 
emergency service or part of a govern-
ment organization) and the geographic 
locations in which ground ambulance 
services are furnished (such as urban, 
rural, and low population density 
areas).
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† HR 1892 EAS2 
‘‘(III) 
LIMITATION.—The 
Sec-
retary shall not include an individual 
provider or supplier of ground ambu-
lance services in the sample under sub-
clause (I) in 2 consecutive years, to the 
extent practicable. 
‘‘(C) REPORTING OF COST INFORMATION.— 
For each year, a provider or supplier of ground 
ambulance services identified by the Secretary 
under subparagraph (B)(i)(II) as being required 
to submit information under the data collection 
system with respect to a period for the year shall 
submit to the Secretary information specified 
under the system. Such information shall be sub-
mitted in a form and manner, and at a time, 
specified by the Secretary for purposes of this 
subparagraph. 
‘‘(D) PAYMENT
REDUCTION
FOR
FAILURE 
TO REPORT.— 
‘‘(i) IN
GENERAL.—Beginning Janu-
ary 1, 2022, subject to clause (ii), a 10 per-
cent reduction to payments under this sub-
section shall be made for the applicable pe-
riod (as defined in clause (ii)) to a provider
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† HR 1892 EAS2 
or supplier of ground ambulance services 
that— 
‘‘(I) is required to submit infor-
mation under the data collection sys-
tem with respect to a period under sub-
paragraph (C); and 
‘‘(II) does not sufficiently submit 
such information, as determined by the 
Secretary. 
‘‘(ii) APPLICABLE PERIOD DEFINED.— 
For purposes of clause (i), the term ‘appli-
cable period’ means, with respect to a pro-
vider or supplier of ground ambulance serv-
ices, a year specified by the Secretary not 
more than 2 years after the end of the pe-
riod with respect to which the Secretary has 
made a determination under clause (i)(II) 
that the provider or supplier of ground am-
bulance services failed to sufficiently submit 
information under the data collection sys-
tem. 
‘‘(iii) 
HARDSHIP
EXEMPTION.—The 
Secretary may exempt a provider or sup-
plier from the payment reduction under 
clause (i) with respect to an applicable pe-
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† HR 1892 EAS2 
riod in the event of significant hardship, 
such as a natural disaster, bankruptcy, or 
other similar situation that the Secretary 
determines interfered with the ability of the 
provider or supplier of ground ambulance 
services to submit such information in a 
timely manner for the specified period. 
‘‘(iv) INFORMAL
REVIEW.—The Sec-
retary shall establish a process under which 
a provider or supplier of ground ambulance 
services may seek an informal review of a 
determination that the provider or supplier 
is subject to the payment reduction under 
clause (i). 
‘‘(E) ONGOING DATA COLLECTION.— 
‘‘(i) REVISION
OF
DATA
COLLECTION 
SYSTEM.—The Secretary may, as the Sec-
retary determines appropriate and, if avail-
able, taking into consideration the report 
(or reports) under subparagraph (F), revise 
the data collection system under subpara-
graph (A). 
‘‘(ii) 
SUBSEQUENT
DATA
COLLEC-
TION.—In order to continue to evaluate the 
extent to which reported costs relate to pay-
284 
† HR 1892 EAS2 
ment rates under this subsection and for 
other purposes the Secretary deems appro-
priate, the Secretary shall require providers 
and suppliers of ground ambulance services 
to submit information for years after 2024 
as the Secretary determines appropriate, 
but in no case less often than once every 3 
years. 
‘‘(F) GROUND
AMBULANCE
DATA
COLLEC-
TION SYSTEM STUDY.— 
‘‘(i) IN
GENERAL.—Not later than 
March 15, 2023, and as determined nec-
essary by the Medicare Payment Advisory 
Commission thereafter, such Commission 
shall assess, and submit to Congress a re-
port on, information submitted by providers 
and suppliers of ground ambulance services 
through the data collection system under 
subparagraph (A), the adequacy of pay-
ments for ground ambulance services under 
this subsection, and geographic variations 
in the cost of furnishing such services. 
‘‘(ii) 
CONTENTS.—A 
report 
under 
clause (i) shall contain the following:
285 
† HR 1892 EAS2 
‘‘(I) An analysis of information 
submitted through the data collection 
system. 
‘‘(II) An analysis of any burden 
on providers and suppliers of ground 
ambulance services associated with the 
data collection system. 
‘‘(III) A recommendation as to 
whether information should continue to 
be submitted through such data collec-
tion system or if such system should be 
revised under subparagraph (E)(i). 
‘‘(IV) Other information deter-
mined appropriate by the Commission. 
‘‘(G) PUBLIC AVAILABILITY.—The Secretary 
shall post information on the results of the data 
collection under this paragraph on the Internet 
website of the Centers for Medicare & Medicaid 
Services, as determined appropriate by the Sec-
retary. 
‘‘(H) 
IMPLEMENTATION.—The 
Secretary 
shall implement this paragraph through notice 
and comment rulemaking. 
‘‘(I) ADMINISTRATION.—Chapter 35 of title 
44, United States Code, shall not apply to the
286 
† HR 1892 EAS2 
collection of information required under this sub-
section. 
‘‘(J) LIMITATIONS ON REVIEW.—There shall 
be no administrative or judicial review under 
section 1869, section 1878, or otherwise of the 
data collection system or identification of re-
spondents under this paragraph. 
‘‘(K) FUNDING FOR IMPLEMENTATION.—For 
purposes of carrying out subparagraph (A), 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 Pro-
gram Management Account for fiscal year 2018. 
Amounts transferred under this subparagraph 
shall remain available until expended.’’. 
SEC. 50204. EXTENSION OF INCREASED INPATIENT HOS-
PITAL PAYMENT ADJUSTMENT FOR CERTAIN 
LOW-VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘fiscal year 2018’’ and 
inserting ‘‘fiscal year 2023’’; 
(2) in subparagraph (C)—
287 
† HR 1892 EAS2 
(A) in clause (i)— 
(i) by striking ‘‘through 2017’’ the first 
place it appears and inserting ‘‘through 
2022’’; and 
(ii) by striking ‘‘ and has less than 800 
discharges’’ and all that follows through the 
period at the end and inserting the fol-
lowing ‘‘and has— 
‘‘(I) with respect to each of fiscal 
years 2005 through 2010, less than 800 
discharges during the fiscal year; 
‘‘(II) with respect to each of fiscal 
years 2011 through 2018, less than 
1,600 discharges of individuals entitled 
to, or enrolled for, benefits under part 
A during the fiscal year or portion of 
fiscal year; 
‘‘(III) with respect to each of fis-
cal years 2019 through 2022, less than 
3,800 discharges during the fiscal year; 
and 
‘‘(IV) with respect to fiscal year 
2023 and each subsequent fiscal year, 
less than 800 discharges during the fis-
cal year.’’; and
288 
† HR 1892 EAS2 
(B) in clause (ii)— 
(i) by striking ‘‘subparagraph (B)’’ 
and inserting ‘‘subparagraphs (B) and 
(D)’’; and 
(ii) by inserting ‘‘(except as provided 
in clause (i)(II) and subparagraph (D)(i))’’ 
after ‘‘regardless’’; and 
(3) in subparagraph (D)— 
(A) by striking ‘‘through 2017’’ and insert-
ing ‘‘through 2022’’; 
(B) by striking ‘‘hospitals with 200 or 
fewer’’ and inserting the following: ‘‘hospitals— 
‘‘(i) with respect to each of fiscal years 
2011 through 2018, with 200 or fewer’’; 
(C) by striking the period at the end and 
inserting ‘‘or portion of fiscal year; and’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(ii) with respect to each of fiscal 
years 2019 through 2022, with 500 or fewer 
discharges in the fiscal year to 0 percent for 
low-volume hospitals with greater than 
3,800 discharges in the fiscal year.’’.
289 
† HR 1892 EAS2 
(b) MEDPAC REPORT ON EXTENSION OF INCREASED 
INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR CER-
TAIN LOW-VOLUME HOSPITALS.— 
(1) IN
GENERAL.—Not later than March 15, 
2022, the Medicare Payment Advisory Commission 
shall submit to Congress a report on the extension of 
the increased inpatient hospital payment adjustment 
for certain low-volume hospitals under section 
1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) under the provisions of, and amend-
ments made by, this section. 
(2) CONTENTS.—The report under paragraph (1) 
shall include an evaluation of the effects of such exten-
sion on the following: 
(A) Beneficiary utilization of inpatient hos-
pital services under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.). 
(B) The financial status of hospitals with a 
low volume of Medicare or total inpatient admis-
sions. 
(C) Program spending under such title 
XVIII. 
(D) Other matters relevant to evaluating the 
effects of such extension.
290 
† HR 1892 EAS2 
SEC. 50205. EXTENSION OF THE MEDICARE-DEPENDENT 
HOSPITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘October 1, 2017’’ 
and inserting ‘‘October 1, 2022’’; 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2017’’ and inserting ‘‘October 1, 2022’’; and 
(3) in clause (iv), by striking subclause (I) and 
inserting the following new subclause: 
‘‘(I) that is located in— 
‘‘(aa) a rural area; or 
‘‘(bb) a State with no rural area (as defined 
in paragraph (2)(D)) and satisfies any of the 
criteria in subclause (I), (II), or (III) of para-
graph (8)(E)(ii),’’; and 
(4) by inserting after subclause (IV) the fol-
lowing new flush sentences: 
‘‘Subclause (I)(bb) shall apply for purposes of payment 
under clause (ii) only for discharges of a hospital occurring 
on or after the effective date of a determination of medicare- 
dependent small rural hospital status made by the Sec-
retary with respect to the hospital after the date of the en-
actment of this sentence. For purposes of applying subclause 
(II) of paragraph (8)(E)(ii) under subclause (I)(bb), such
291 
† HR 1892 EAS2 
subclause (II) shall be applied by inserting ‘as of January 
1, 2018,’ after ‘such State’ each place it appears.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION
OF
TARGET
AMOUNT.—Section 
1886(b)(3)(D) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘October 1, 2017’’ and inserting ‘‘Octo-
ber 1, 2022’’; and 
(B) in clause (iv), by striking ‘‘through fis-
cal year 2017’’ and inserting ‘‘through fiscal 
year 2022’’. 
(2) PERMITTING
HOSPITALS
TO
DECLINE
RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by striking ‘‘through fiscal 
year 2017’’ and inserting ‘‘through fiscal year 2022’’. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
medicare-dependent, small rural hospital program 
under section 1886(d) of the Social Security Act (42 
U.S.C. 1395x(d)). Such study shall include an anal-
ysis of the following:
292 
† HR 1892 EAS2 
(A) The payor mix of medicare-dependent, 
small rural hospitals (as defined in paragraph 
(5)(G)(iv) of such section 1886(d)), how such 
mix will trend in future years (based on current 
trends and projections), and whether or not the 
requirement under subclause (IV) of such para-
graph should be revised. 
(B) The characteristics of medicare-depend-
ent, small rural hospitals that meet the require-
ment of such subclause (IV) through the applica-
tion of paragraph (a)(iii)(A) or (a)(iii)(B) of 
section 412.108 of title 42, Code of Federal Regu-
lations, including Medicare inpatient and out-
patient utilization, payor mix, and financial 
status (including Medicare and total margins), 
and whether or not Medicare payments for such 
hospitals should be revised. 
(C) Such other items related to medicare-de-
pendent, small rural hospitals as the Comptroller 
General determines appropriate. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
293 
† HR 1892 EAS2 
tion and administrative action as the Comptroller 
General determines appropriate. 
SEC. 50206. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE ENDORSEMENT, INPUT, AND SELECTION; 
REPORTING REQUIREMENTS. 
(a) EXTENSION OF FUNDING.—Section 1890(d)(2) of 
the Social Security Act (42 U.S.C. 1395aaa(d)(2)) is 
amended— 
(1) in the first sentence— 
(A) by striking ‘‘2014 and’’ and inserting 
‘‘2014,’’; and 
(B) by inserting the following before the pe-
riod: ‘‘, and $7,500,000 for each of fiscal years 
2018 and 2019’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘Amounts transferred for each of fiscal years 
2018 and 2019 shall be in addition to any unobli-
gated funds transferred for a preceding fiscal year 
that are available under the preceding sentence.’’ 
(b) ANNUAL REPORT BY SECRETARY TO CONGRESS.— 
Section 1890 of the Social Security Act (42 U.S.C. 
1395aaa) is amended by adding at the end the following 
new subsection: 
‘‘(e) ANNUAL
REPORT
BY
SECRETARY
TO
CON-
GRESS.—By not later than March 1 of each year (beginning
294 
† HR 1892 EAS2 
with 2019), the Secretary shall submit to Congress a report 
containing the following: 
‘‘(1) A comprehensive plan that identifies the 
quality measurement needs of programs and initia-
tives of the Secretary and provides a strategy for 
using the entity with a contract under subsection (a) 
and any other entity the Secretary has contracted 
with or may contract with to perform work associated 
with section 1890A to help meet those needs, specifi-
cally with respect to the programs under this title 
and title XIX. In years after the first plan under this 
paragraph is submitted, the requirements of this 
paragraph may be met by providing an update to the 
plan. 
‘‘(2) The amount of funding provided under sub-
section (d) for purposes of carrying out this section 
and section 1890A that has been obligated by the Sec-
retary, the amount of funding provided that has been 
expended, and the amount of funding provided that 
remains unobligated. 
‘‘(3) With respect to the activities described 
under this section or section 1890A, a description of 
how the funds described in paragraph (2) have been 
obligated or expended, including how much of that 
funding has been obligated or expended for work per-
295 
† HR 1892 EAS2 
formed by the Secretary, the entity with a contract 
under subsection (a), and any other entity the Sec-
retary has contracted with to perform work. 
‘‘(4) A description of the activities for which the 
funds described in paragraph (2) were used, includ-
ing task orders and activities assigned to the entity 
with a contract under subsection (a), activities per-
formed by the Secretary, and task orders and activi-
ties assigned to any other entity the Secretary has 
contracted with to perform work related to carrying 
out section 1890A. 
‘‘(5) The amount of funding described in para-
graph (2) that has been obligated or expended for each 
of the activities described in paragraph (4). 
‘‘(6) Estimates for, and descriptions of, obliga-
tions and expenditures that the Secretary anticipates 
will be needed in the succeeding two year period to 
carry out each of the quality measurement activities 
required under this section and section 1890A, includ-
ing any obligations that will require funds to be ex-
pended in a future year.’’. 
(c) REVISIONS
TO ANNUAL REPORT FROM CON-
SENSUS-BASED ENTITY
TO CONGRESS
AND
THE SEC-
RETARY.—
296 
† HR 1892 EAS2 
(1) IN GENERAL.—Section 1890(b)(5)(A) of the 
Social Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is 
amended— 
(A) by redesignating clauses (i) through (vi) 
as subclauses (I) through (VI), respectively, and 
moving the margins accordingly; 
(B) in the matter preceding subclause (I), 
as redesignated by subparagraph (A), by striking 
‘‘containing a description of—’’ and inserting 
‘‘containing the following: 
‘‘(i) A description of—’’; and 
(C) by adding at the end the following new 
clauses: 
‘‘(ii) An itemization of financial infor-
mation for the fiscal year ending September 
30 of the preceding year, including— 
‘‘(I) annual revenues of the entity 
(including any government funding, 
private sector contributions, grants, 
membership revenues, and investment 
revenue); 
‘‘(II) annual expenses of the enti-
ty (including grants paid, benefits 
paid, salaries or other compensation,
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† HR 1892 EAS2 
fundraising expenses, and overhead 
costs); and 
‘‘(III) a breakdown of the amount 
awarded per contracted task order and 
the specific projects funded in each task 
order assigned to the entity. 
‘‘(iii) Any updates or modifications of 
internal policies and procedures of the enti-
ty as they relate to the duties of the entity 
under this section, including— 
‘‘(I) specifically identifying any 
modifications to the disclosure of inter-
ests and conflicts of interests for com-
mittees, work groups, task forces, and 
advisory panels of the entity; and 
‘‘(II) information on external 
stakeholder participation in the duties 
of the entity under this section (includ-
ing complete rosters for all committees, 
work groups, task forces, and advisory 
panels funded through government con-
tracts, descriptions of relevant interests 
and any conflicts of interest for mem-
bers of all committees, work groups, 
task forces, and advisory panels, and
298 
† HR 1892 EAS2 
the total percentage by health care sec-
tor of all convened committees, work 
groups, task forces, and advisory pan-
els.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to reports submitted for 
years beginning with 2019. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on health care 
quality measurement efforts funded under sections 
1890 and 1890A of the Social Security Act (42 
U.S.C. 1395aaa; 1395aaa–1). Such study shall in-
clude an examination of the following: 
(A) The extent to which the Secretary of 
Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) has set and 
prioritized objectives to be achieved for each of 
the quality measurement activities required 
under such sections 1890 and 1890A. 
(B) The efforts that the Secretary has un-
dertaken to meet quality measurement objectives 
associated with such sections 1890 and 1890A, 
including division of responsibilities for those ef-
forts within the Department of Health and
299 
† HR 1892 EAS2 
Human Services and through contracts with a 
consensus-based entity under subsection (a) of 
such section 1890 (in this subsection referred to 
as the ‘‘consensus-based entity’’) and other enti-
ties, and the extent of any overlap among the 
work performed by the Secretary, the consensus- 
based entity, the Measure Applications Partner-
ship (MAP) convened by such entity to provide 
input to the Secretary on the selection of quality 
and efficiency measures, and any other entities 
the Secretary has contracted with to perform 
work related to carrying out such sections 1890 
and 1890A. 
(C) The total amount of funding provided 
to the Secretary for purposes of carrying out 
such sections 1890 and 1890A, the amount of 
such funding that has been obligated or expended 
by the Secretary, and the amount of such fund-
ing that remains unobligated. 
(D) How the funds described in subpara-
graph (C) have been allocated, including how 
much of the funding has been allocated for work 
performed by the Secretary, the consensus-based 
entity, and any other entity the Secretary has 
contracted with to perform work related to car-
300 
† HR 1892 EAS2 
rying out such sections 1890 and 1890A, respec-
tively, and descriptions of such work. 
(E) The extent to which the Secretary has 
developed a comprehensive and long-term plan to 
ensure that it can achieve quality measurement 
objectives related to carrying out such sections 
1890 and 1890A in a timely manner and with 
efficient use of available resources, including the 
roles of the consensus-based entity, the Measure 
Applications Partnership (MAP), and any other 
entity the Secretary has contracted with to per-
form work related to such sections 1890 and 
1890A in helping the Secretary achieve those ob-
jectives. 
(2) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a report 
containing the results of the study conducted under 
paragraph (1), together with recommendations for 
such legislation and administrative action as the 
Comptroller General determines appropriate.
301 
† HR 1892 EAS2 
SEC. 50207. EXTENSION OF FUNDING OUTREACH AND AS-
SISTANCE 
FOR 
LOW-INCOME 
PROGRAMS; 
STATE 
HEALTH 
INSURANCE 
ASSISTANCE 
PROGRAM REPORTING REQUIREMENTS. 
(a) FUNDING EXTENSIONS.— 
(1) ADDITIONAL FUNDING FOR STATE HEALTH 
INSURANCE PROGRAMS.—Subsection (a)(1)(B) of sec-
tion 119 of the Medicare Improvements for Patients 
and Providers Act of 2008 (42 U.S.C. 1395b–3 note), 
as amended by section 3306 of the Patient Protection 
and Affordable Care Act (Public Law 111–148), sec-
tion 610 of the American Taxpayer Relief Act of 2012 
(Public Law 112–240), section 1110 of the Pathway 
for SGR Reform Act of 2013 (Public Law 113–67), 
section 110 of the Protecting Access to Medicare Act 
of 2014 (Public Law 113–93), and section 208 of the 
Medicare Access and CHIP Reauthorization Act of 
2015 (Public Law 114–10) is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clauses: 
‘‘(viii) 
for 
fiscal 
year 
2018, 
of 
$13,000,000; and
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† HR 1892 EAS2 
‘‘(ix) 
for 
fiscal 
year 
2019, 
of 
$13,000,000.’’. 
(2) ADDITIONAL FUNDING FOR AREA AGENCIES 
ON AGING.—Subsection (b)(1)(B) of such section 119, 
as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clauses: 
‘‘(viii) 
for 
fiscal 
year 
2018, 
of 
$7,500,000; and 
‘‘(ix) 
for 
fiscal 
year 
2019, 
of 
$7,500,000.’’. 
(3) ADDITIONAL FUNDING FOR AGING AND DIS-
ABILITY
RESOURCE
CENTERS.—Subsection (c)(1)(B) 
of such section 119, as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clauses:
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† HR 1892 EAS2 
‘‘(viii) 
for 
fiscal 
year 
2018, 
of 
$5,000,000; and 
‘‘(ix) 
for 
fiscal 
year 
2019, 
of 
$5,000,000.’’. 
(4) ADDITIONAL FUNDING FOR CONTRACT WITH 
THE
NATIONAL
CENTER
FOR
BENEFITS
AND
OUT-
REACH ENROLLMENT.—Subsection (d)(2) of such sec-
tion 119, as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clauses: 
‘‘(viii) 
for 
fiscal 
year 
2018, 
of 
$12,000,000; and 
‘‘(ix) 
for 
fiscal 
year 
2019, 
of 
$12,000,000.’’. 
(b) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAM REPORTING REQUIREMENTS.—Beginning not later 
than April 1, 2019, and biennially thereafter, the Agency 
for Community Living shall electronically post on its 
website the following information, with respect to grants to 
States for State health insurance assistance programs, (such 
information to be presented by State and by entity receiv-
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† HR 1892 EAS2 
ing funds from the State to carry out such a program fund-
ed by such grant): 
(1) The amount of Federal funding provided to 
each such State for such program for the period in-
volved and the amount of Federal funding provided 
by each such State for such program to each such en-
tity for the period involved. 
(2) Information as the Secretary may specify, 
with respect to such programs carried out through 
such grants, consistent with the terms and conditions 
for receipt of such grants. 
SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON. 
(a) EXTENSION.— 
(1) IN GENERAL.—Section 421 of the Medicare 
Prescription Drug, Improvement, and Modernization 
Act of 2003 (Public Law 108–173; 117 Stat. 2283; 42 
U.S.C. 1395fff note), as amended by section 5201(b) 
of the Deficit Reduction Act of 2005 (Public Law 
109–171; 120 Stat. 46), section 3131(c) of the Patient 
Protection and Affordable Care Act (Public Law 111– 
148; 124 Stat. 428), and section 210 of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Pub-
lic Law 114–10; 129 Stat. 151) is amended—
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† HR 1892 EAS2 
(A) in subsection (a), by striking ‘‘January 
1, 2018’’ and inserting ‘‘January 1, 2019’’ each 
place it appears; 
(B) by redesignating subsections (b) and (c) 
as subsections (c) and (d), respectively; 
(C) in each of subsections (c) and (d), as so 
redesignated, by striking ‘‘subsection (a)’’ and 
inserting ‘‘subsection (a) or (b)’’; and 
(D) by inserting after subsection (a) the fol-
lowing new subsection: 
‘‘(b) SUBSEQUENT TEMPORARY INCREASE.— 
‘‘(1) IN GENERAL.—The Secretary shall increase 
the payment amount otherwise made under such sec-
tion 1895 for home health services furnished in a 
county (or equivalent area) in a rural area (as de-
fined in such section 1886(d)(2)(D)) that, as deter-
mined by the Secretary— 
‘‘(A) is in the highest quartile of all coun-
ties (or equivalent areas) based on the number of 
Medicare home health episodes furnished per 100 
individuals who are entitled to, or enrolled for, 
benefits under part A of title XVIII of the Social 
Security Act or enrolled for benefits under part 
B of such title (but not enrolled in a plan under 
part C of such title)—
306 
† HR 1892 EAS2 
‘‘(i) in the case of episodes and visits 
ending during 2019, by 1.5 percent; and 
‘‘(ii) in the case of episodes and visits 
ending during 2020, by 0.5 percent; 
‘‘(B) has a population density of 6 individ-
uals or fewer per square mile of land area and 
is not described in subparagraph (A)— 
‘‘(i) in the case of episodes and visits 
ending during 2019, by 4 percent; 
‘‘(ii) in the case of episodes and visits 
ending during 2020, by 3 percent; 
‘‘(iii) in the case of episodes and visits 
ending during 2021, by 2 percent; and 
‘‘(iv) in the case of episodes and visits 
ending during 2022, by 1 percent; and 
‘‘(C) is not described in either subpara-
graph (A) or (B)— 
‘‘(i) in the case of episodes and visits 
ending during 2019, by 3 percent; 
‘‘(ii) in the case of episodes and visits 
ending during 2020, by 2 percent; and 
‘‘(iii) in the case of episodes and visits 
ending during 2021, by 1 percent. 
‘‘(2) RULES FOR DETERMINATIONS.—
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† HR 1892 EAS2 
‘‘(A) NO SWITCHING.—For purposes of this 
subsection, the determination by the Secretary as 
to which subparagraph of paragraph (1) applies 
to a county (or equivalent area) shall be made 
a single time and shall apply for the duration 
of the period to which this subsection applies. 
‘‘(B) UTILIZATION.—In determining which 
counties (or equivalent areas) are in the highest 
quartile under paragraph (1)(A), the following 
rules shall apply: 
‘‘(i) The Secretary shall use data from 
2015. 
‘‘(ii) The Secretary shall exclude data 
from the territories (and the territories shall 
not be described in such paragraph). 
‘‘(iii) The Secretary may exclude data 
from counties (or equivalent areas) in rural 
areas with a low volume of home health epi-
sodes (and if data is so excluded with re-
spect to a county (or equivalent area), such 
county (or equivalent area) shall not be de-
scribed in such paragraph). 
‘‘(C) 
POPULATION
DENSITY.—In 
deter-
mining population density under paragraph
308 
† HR 1892 EAS2 
(1)(B), the Secretary shall use data from the 
2010 decennial Census. 
‘‘(3) LIMITATIONS ON REVIEW.—There shall be 
no administrative or judicial review under section 
1869, section 1878, or otherwise of determinations 
under paragraph (1).’’. 
(2) REQUIREMENT TO SUBMIT COUNTY DATA ON 
CLAIM FORM.—Section 1895(c) of the Social Security 
Act (42 U.S.C. 1395fff(c)) is amended— 
(A) in paragraph (1), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (2), by striking the period 
at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(3) in the case of home health services furnished 
on or after January 1, 2019, the claim contains the 
code for the county (or equivalent area) in which the 
home health service was furnished.’’. 
(b) HHS OIG ANALYSIS.—Not later than January 1, 
2023, the Inspector General of the Department of Health 
and Human Services shall submit to Congress— 
(1) an analysis of the home health claims and 
utilization of home health services by county (or 
equivalent area) under the Medicare program; and
309 
† HR 1892 EAS2 
(2) recommendations the Inspector General de-
termines appropriate based on such analysis. 
TITLE 
III—CREATING 
HIGH- 
QUALITY RESULTS AND OUT-
COMES NECESSARY TO IM-
PROVE CHRONIC (CHRONIC) 
CARE 
Subtitle A—Receiving High Quality 
Care in the Home 
SEC. 50301. EXTENDING THE INDEPENDENCE AT HOME 
DEMONSTRATION PROGRAM. 
(a) IN GENERAL.—Section 1866E of the Social Secu-
rity Act (42 U.S.C. 1395cc–5) is amended— 
(1) in subsection (e)— 
(A) in paragraph (1)— 
(i) by striking ‘‘An agreement’’ and in-
serting ‘‘Agreements’’; and 
(ii) by striking ‘‘5-year’’ and inserting 
‘‘7-year’’; and 
(B) in paragraph (5)— 
(i) by striking ‘‘10,000’’ and inserting 
‘‘15,000’’; and 
(ii) by adding at the end the following 
new sentence: ‘‘An applicable beneficiary 
that participates in the demonstration pro-
310 
† HR 1892 EAS2 
gram by reason of the increase from 10,000 
to 15,000 in the preceding sentence pursu-
ant to the amendment made by section 
50301(a)(1)(B)(i) of the Advancing Chronic 
Care, Extenders, and Social Services Act 
shall be considered in the spending target 
estimates under paragraph (1) of subsection 
(c) and the incentive payment calculations 
under paragraph (2) of such subsection for 
the sixth and seventh years of such pro-
gram.’’; 
(2) in subsection (g), in the first sentence, by in-
serting ‘‘, including, to the extent practicable, with re-
spect to the use of electronic health information sys-
tems, as described in subsection (b)(1)(A)(vi)’’ after 
‘‘under the demonstration program’’; and 
(3) in subsection (i)(1)(A), by striking ‘‘will not 
receive an incentive payment for the second of 2’’ and 
inserting ‘‘did not achieve savings for the third of 3’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a)(3) shall take effect as if included in the enact-
ment of Public Law 111–148.
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† HR 1892 EAS2 
SEC. 50302. EXPANDING ACCESS TO HOME DIALYSIS THER-
APY. 
(a) IN GENERAL.—Section 1881(b)(3) of the Social Se-
curity Act (42 U.S.C. 1395rr(b)(3)) is amended— 
(1) by redesignating subparagraphs (A) and (B) 
as clauses (i) and (ii), respectively; 
(2) in clause (ii), as redesignated by paragraph 
(1), by striking ‘‘on a comprehensive’’ and insert 
‘‘subject to subparagraph (B), on a comprehensive’’; 
(3) by striking ‘‘With respect to’’ and inserting 
‘‘(A) With respect to’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(B)(i) For purposes of subparagraph (A)(ii), subject 
to clause (ii), an individual determined to have end stage 
renal disease receiving home dialysis may choose to receive 
monthly end stage renal disease-related clinical assessments 
furnished on or after January 1, 2019, via telehealth. 
‘‘(ii) Clause (i) shall apply to an individual only if 
the individual receives a face-to-face clinical assessment, 
without the use of telehealth— 
‘‘(I) in the case of the initial 3 months of home 
dialysis of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once 
every 3 consecutive months.’’. 
(b) ORIGINATING SITE REQUIREMENTS.—
312 
† HR 1892 EAS2 
(1) IN GENERAL.—Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended— 
(A) in paragraph (4)(C)(ii), by adding at 
the end the following new subclauses: 
‘‘(IX) A renal dialysis facility, 
but only for purposes of section 
1881(b)(3)(B). 
‘‘(X) The home of an individual, 
but only for purposes of section 
1881(b)(3)(B).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY 
ESRD-RELATED VISIT.—The geographic requirements 
described in paragraph (4)(C)(i) shall not apply with 
respect to telehealth services furnished on or after 
January 
1, 
2019, 
for 
purposes 
of 
section 
1881(b)(3)(B), at an originating site described in 
subclause (VI), (IX), or (X) of paragraph (4)(C)(ii).’’. 
(2) NO FACILITY FEE IF ORIGINATING SITE FOR 
HOME
DIALYSIS
THERAPY
IS
THE
HOME.—Section 
1834(m)(2)(B) of the Social Security (42 U.S.C. 
1395m(m)(2)(B)) is amended—
313 
† HR 1892 EAS2 
(A) by redesignating clauses (i) and (ii) as 
subclauses (I) and (II), and indenting appro-
priately; 
(B) in subclause (II), as redesignated by 
subparagraph (A), by striking ‘‘clause (i) or this 
clause’’ and inserting ‘‘subclause (I) or this sub-
clause’’; 
(C) by striking ‘‘SITE.—With respect to’’ 
and inserting ‘‘SITE.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), with respect to’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(ii) NO FACILITY FEE IF ORIGINATING 
SITE FOR HOME DIALYSIS THERAPY IS THE 
HOME.—No facility fee shall be paid under 
this subparagraph to an originating site de-
scribed in paragraph (4)(C)(ii)(X).’’. 
(c) CLARIFICATION REGARDING TELEHEALTH PRO-
VIDED TO BENEFICIARIES.—Section 1128A(i)(6) of the So-
cial Security Act (42 U.S.C. 1320a–7a(i)(6)) is amended— 
(1) in subparagraph (H), by striking ‘‘or’’ at the 
end; 
(2) in subparagraph (I), by striking the period 
at the end and inserting ‘‘; or’’; and
314 
† HR 1892 EAS2 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(J) the provision of telehealth technologies 
(as defined by the Secretary) on or after Janu-
ary 1, 2019, by a provider of services or a renal 
dialysis facility (as such terms are defined for 
purposes of title XVIII) to an individual with 
end stage renal disease who is receiving home di-
alysis for which payment is being made under 
part B of such title, if— 
‘‘(i) the telehealth technologies are not 
offered as part of any advertisement or so-
licitation; 
‘‘(ii) the telehealth technologies are pro-
vided for the purpose of furnishing tele-
health services related to the individual’s 
end stage renal disease; and 
‘‘(iii) the provision of the telehealth 
technologies meets any other requirements 
set forth in regulations promulgated by the 
Secretary.’’. 
(d) CONFORMING AMENDMENT.—Section 1881(b)(1) of 
the Social Security Act (42 U.S.C. 1395rr(b)(1)) is amend-
ed by striking ‘‘paragraph (3)(A)’’ and inserting ‘‘para-
graph (3)(A)(i)’’.
315 
† HR 1892 EAS2 
Subtitle B—Advancing Team-Based 
Care 
SEC. 50311. PROVIDING CONTINUED ACCESS TO MEDICARE 
ADVANTAGE SPECIAL NEEDS PLANS FOR VUL-
NERABLE POPULATIONS. 
(a) EXTENSION.—Section 1859(f)(1) of the Social Se-
curity Act (42 U.S.C. 1395w–28(f)(1)) is amended by strik-
ing ‘‘and for periods before January 1, 2019’’. 
(b) INCREASED INTEGRATION OF DUAL SNPS.— 
(1) IN GENERAL.—Section 1859(f) of the Social 
Security Act (42 U.S.C. 1395w–28(f)) is amended— 
(A) in paragraph (3), by adding at the end 
the following new subparagraph: 
‘‘(F) The plan meets the requirements ap-
plicable under paragraph (8).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(8) INCREASED INTEGRATION OF DUAL SNPS.— 
‘‘(A) DESIGNATED
CONTACT.—The Sec-
retary, acting through the Federal Coordinated 
Health Care Office established under section 
2602 of Public Law 111–148, shall serve as a 
dedicated point of contact for States to address 
misalignments that arise with the integration of 
specialized MA plans for special needs individ-
316 
† HR 1892 EAS2 
uals described in subsection (b)(6)(B)(ii) under 
this paragraph and, consistent with such role, 
shall establish— 
‘‘(i) a uniform process for dissemi-
nating to State Medicaid agencies informa-
tion under this title impacting contracts be-
tween such agencies and such plans under 
this subsection; and 
‘‘(ii) basic resources for States inter-
ested in exploring such plans as a platform 
for integration, such as a model contract or 
other tools to achieve those goals. 
‘‘(B) UNIFIED
GRIEVANCES
AND
APPEALS 
PROCESS.— 
‘‘(i) IN
GENERAL.—Not later than 
April 1, 2020, the Secretary shall establish 
procedures, to the extent feasible as deter-
mined by the Secretary, unifying grievances 
and appeals procedures under sections 
1852(f), 1852(g), 1902(a)(3), 1902(a)(5), 
and 1932(b)(4) for items and services pro-
vided by specialized MA plans for special 
needs individuals described in subsection 
(b)(6)(B)(ii) under this title and title XIX. 
With respect to items and services described
317 
† HR 1892 EAS2 
in the preceding sentence, procedures estab-
lished under this clause shall apply in place 
of otherwise applicable grievances and ap-
peals procedures. The Secretary shall solicit 
comment in developing such procedures 
from States, plans, beneficiaries and their 
representatives, and other relevant stake-
holders. 
‘‘(ii) PROCEDURES.—The procedures 
established under clause (i) shall be in-
cluded in the plan contract under para-
graph (3)(D) and shall— 
‘‘(I) adopt the provisions for the 
enrollee that are most protective for the 
enrollee and, to the extent feasible as 
determined by the Secretary, are com-
patible with unified timeframes and 
consolidated access to external review 
under an integrated process; 
‘‘(II) take into account differences 
in State plans under title XIX to the 
extent necessary; 
‘‘(III) be easily navigable by an 
enrollee; and
318 
† HR 1892 EAS2 
‘‘(IV) include the elements de-
scribed in clause (iii), as applicable. 
‘‘(iii) ELEMENTS
DESCRIBED.—Both 
unified appeals and unified grievance pro-
cedures shall include, as applicable, the fol-
lowing elements described in this clause: 
‘‘(I) Single written notification of 
all applicable grievances and appeal 
rights under this title and title XIX. 
For purposes of this subparagraph, the 
Secretary may waive the requirements 
under section 1852(g)(1)(B) when the 
specialized MA plan covers items or 
services under this part or under title 
XIX. 
‘‘(II) Single pathways for resolu-
tion of any grievance or appeal related 
to a particular item or service pro-
vided by specialized MA plans for spe-
cial needs individuals described in sub-
section (b)(6)(B)(ii) under this title 
and title XIX. 
‘‘(III) Notices written in plain 
language and available in a language 
and format that is accessible to the en-
319 
† HR 1892 EAS2 
rollee, including in non-English lan-
guages that are prevalent in the service 
area of the specialized MA plan. 
‘‘(IV) 
Unified 
timeframes 
for 
grievances and appeals processes, such 
as an individual’s filing of a grievance 
or appeal, a plan’s acknowledgment 
and resolution of a grievance or ap-
peal, and notification of decisions with 
respect to a grievance or appeal. 
‘‘(V) Requirements for how the 
plan must process, track, and resolve 
grievances and appeals, to ensure bene-
ficiaries are notified on a timely basis 
of decisions that are made throughout 
the grievance or appeals process and 
are able to easily determine the status 
of a grievance or appeal. 
‘‘(iv) CONTINUATION
OF
BENEFITS 
PENDING APPEAL.—The unified procedures 
under clause (i) shall, with respect to all 
benefits under parts A and B and title XIX 
subject to appeal under such procedures, in-
corporate provisions under current law and 
implementing regulations that provide con-
320 
† HR 1892 EAS2 
tinuation of benefits pending appeal under 
this title and title XIX. 
‘‘(C) REQUIREMENT
FOR
UNIFIED
GRIEV-
ANCES AND APPEALS.—For 2021 and subsequent 
years, the contract of a specialized MA plan for 
special needs individuals described in subsection 
(b)(6)(B)(ii) with a State Medicaid agency 
under paragraph (3)(D) shall require the use of 
unified grievances and appeals procedures as de-
scribed in subparagraph (B). 
‘‘(D) REQUIREMENTS FOR INTEGRATION.— 
‘‘(i) IN GENERAL.—For 2021 and sub-
sequent years, a specialized MA plan for 
special needs individuals described in sub-
section (b)(6)(B)(ii) shall meet one or more 
of the following requirements, to the extent 
permitted under State law, for integration 
of benefits under this title and title XIX: 
‘‘(I) The specialized MA plan 
must meet the requirements of con-
tracting with the State Medicaid agen-
cy described in paragraph (3)(D) in 
addition to coordinating long-term 
services and supports or behavioral 
health services, or both, by meeting an
321 
† HR 1892 EAS2 
additional minimum set of require-
ments determined by the Secretary 
through 
the 
Federal 
Coordinated 
Health Care Office established under 
section 2602 of the Patient Protection 
and Affordable Care Act based on 
input from stakeholders, such as noti-
fying the State in a timely manner of 
hospitalizations, emergency room vis-
its, and hospital or nursing home dis-
charges of enrollees, assigning one pri-
mary care provider for each enrollee, 
or sharing data that would benefit the 
coordination of items and services 
under this title and the State plan 
under title XIX. Such minimum set of 
requirements must be included in the 
contract of the specialized MA plan 
with the State Medicaid agency under 
such paragraph. 
‘‘(II) The specialized MA plan 
must meet the requirements of a fully 
integrated plan described in section 
1853(a)(1)(B)(iv)(II) (other than the 
requirement that the plan have similar
322 
† HR 1892 EAS2 
average levels of frailty, as determined 
by the Secretary, as the PACE pro-
gram), or enter into a capitated con-
tract with the State Medicaid agency 
to provide long-term services and sup-
ports or behavioral health services, or 
both. 
‘‘(III) In the case of a specialized 
MA plan that is offered by a parent or-
ganization that is also the parent orga-
nization of a Medicaid managed care 
organization providing long term serv-
ices and supports or behavioral services 
under 
a 
contract 
under 
section 
1903(m), the parent organization must 
assume clinical and financial responsi-
bility for benefits provided under this 
title and title XIX with respect to any 
individual who is enrolled in both the 
specialized MA plan and the Medicaid 
managed care organization. 
‘‘(ii) SUSPENSION
OF
ENROLLMENT 
FOR
FAILURE
TO
MEET
REQUIREMENTS 
DURING INITIAL PERIOD.—During the pe-
riod of plan years 2021 through 2025, if the
323 
† HR 1892 EAS2 
Secretary determines that a specialized MA 
plan for special needs individuals described 
in subsection (b)(6)(B)(ii) has failed to 
comply with clause (i), the Secretary may 
provide for the application against the 
Medicare Advantage organization offering 
the plan of the remedy described in section 
1857(g)(2)(B) in the same manner as the 
Secretary may apply such remedy, and in 
accordance with the same procedures as 
would apply, in the case of an MA organi-
zation determined by the Secretary to have 
engaged in conduct described in section 
1857(g)(1). If the Secretary applies such 
remedy to a Medicare Advantage organiza-
tion under the preceding sentence, the orga-
nization shall submit to the Secretary (at a 
time, and in a form and manner, specified 
by the Secretary) information describing 
how the plan will come into compliance 
with clause (i). 
‘‘(E) STUDY AND REPORT TO CONGRESS.— 
‘‘(i) IN
GENERAL.—Not later than 
March 15, 2022, and, subject to clause (iii), 
biennially thereafter through 2032, the
324 
† HR 1892 EAS2 
Medicare Payment Advisory Commission 
established under section 1805, in consulta-
tion with the Medicaid and CHIP Payment 
and Access Commission established under 
section 1900, shall conduct (and submit to 
the Secretary and the Committees on Ways 
and Means and Energy and Commerce of 
the House of Representatives and the Com-
mittee on Finance of the Senate a report 
on) a study to determine how specialized 
MA plans for special needs individuals de-
scribed in subsection (b)(6)(B)(ii) perform 
among each other based on data from 
Healthcare Effectiveness Data and Informa-
tion Set (HEDIS) quality measures, re-
ported on the plan level, as required under 
section 1852(e)(3) (or such other measures 
or data sources that are available and ap-
propriate, such as encounter data and Con-
sumer Assessment of Healthcare Providers 
and Systems data, as specified by such 
Commissions as enabling an accurate eval-
uation under this subparagraph). Such 
study shall include, as feasible, the following 
comparison groups of specialized MA plans
325 
† HR 1892 EAS2 
for special needs individuals described in 
subsection (b)(6)(B)(ii): 
‘‘(I) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(I). 
‘‘(II) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(II). 
‘‘(III) A comparison group of 
such plans operating within the Fi-
nancial Alignment Initiative dem-
onstration for the period for which 
such plan is so operating and the dem-
onstration is in effect, and, in the case 
that an integration option that is not 
with respect to specialized MA plans 
for special needs individuals is estab-
lished after the conclusion of the dem-
onstration involved. 
‘‘(IV) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(III). 
‘‘(V) A comparison group of MA 
plans, as feasible, not described in a 
previous subclause of this clause, with
326 
† HR 1892 EAS2 
respect to the performance of such 
plans for enrollees who are special 
needs individuals described in sub-
section (b)(6)(B)(ii). 
‘‘(ii) ADDITIONAL
REPORTS.—Begin-
ning with 2033 and every five years there-
after, the Medicare Payment Advisory Com-
mission, in consultation with the Medicaid 
and CHIP Payment and Access Commis-
sion, shall conduct a study described in 
clause (i).’’. 
(2) CONFORMING AMENDMENT TO RESPONSIBIL-
ITIES OF FEDERAL COORDINATED HEALTH CARE OF-
FICE.—Section 2602(d) of Public Law 111–148 (42 
U.S.C. 1315b(d)) is amended by adding at the end the 
following new paragraphs: 
‘‘(6) To act as a designated contact for States 
under subsection (f)(8)(A) of section 1859 of the So-
cial Security Act (42 U.S.C. 1395w–28) with respect 
to the integration of specialized MA plans for special 
needs individuals described in subsection (b)(6)(B)(ii) 
of such section. 
‘‘(7) To be responsible, subject to the final ap-
proval of the Secretary, for developing regulations 
and guidance related to the implementation of a uni-
327 
† HR 1892 EAS2 
fied grievance and appeals process as described in 
subparagraphs (B) and (C) of section 1859(f)(8) of 
the Social Security Act (42 U.S.C. 1395w–28(f)(8)). 
‘‘(8) To be responsible, subject to the final ap-
proval of the Secretary, for developing regulations 
and guidance related to the integration or alignment 
of policy and oversight under the Medicare program 
under title XVIII of such Act and the Medicaid pro-
gram under title XIX of such Act regarding special-
ized MA plans for special needs individuals described 
in subsection (b)(6)(B)(ii) of such section 1859.’’. 
(c) IMPROVEMENTS TO SEVERE OR DISABLING CHRON-
IC CONDITION SNPS.— 
(1) CARE
MANAGEMENT
REQUIREMENTS.—Sec-
tion 1859(f)(5) of the Social Security Act (42 U.S.C. 
1395w–28(f)(5)) is amended— 
(A) by striking ‘‘ALL SNPS.—The require-
ments’’ and inserting ‘‘ALL SNPS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the requirements’’; 
(B) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively, and 
indenting appropriately; and 
(C) in clause (ii), as redesignated by sub-
paragraph (B), by redesignating clauses (i)
328 
† HR 1892 EAS2 
through (iii) as subclauses (I) through (III), re-
spectively, and indenting appropriately; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(B) IMPROVEMENTS
TO
CARE
MANAGE-
MENT
REQUIREMENTS
FOR
SEVERE
OR
DIS-
ABLING
CHRONIC
CONDITION
SNPS.—For 2020 
and subsequent years, in the case of a specialized 
MA plan for special needs individuals described 
in subsection (b)(6)(B)(iii), the requirements de-
scribed in this paragraph include the following: 
‘‘(i) The interdisciplinary team under 
subparagraph (A)(ii)(III) includes a team 
of providers with demonstrated expertise, 
including training in an applicable spe-
cialty, in treating individuals similar to the 
targeted population of the plan. 
‘‘(ii) Requirements developed by the 
Secretary to provide face-to-face encounters 
with individuals enrolled in the plan not 
less frequently than on an annual basis. 
‘‘(iii) As part of the model of care 
under clause (i) of subparagraph (A), the 
results of the initial assessment and annual 
reassessment under clause (ii)(I) of such
329 
† HR 1892 EAS2 
subparagraph of each individual enrolled in 
the plan are addressed in the individual’s 
individualized care plan under clause 
(ii)(II) of such subparagraph. 
‘‘(iv) As part of the annual evaluation 
and approval of such model of care, the Sec-
retary shall take into account whether the 
plan fulfilled the previous year’s goals (as 
required under the model of care). 
‘‘(v) The Secretary shall establish a 
minimum benchmark for each element of the 
model of care of a plan. The Secretary shall 
only approve a plan’s model of care under 
this paragraph if each element of the model 
of care meets the minimum benchmark ap-
plicable under the preceding sentence.’’. 
(2) REVISIONS TO THE DEFINITION OF A SEVERE 
OR
DISABLING
CHRONIC
CONDITIONS
SPECIALIZED 
NEEDS INDIVIDUAL.— 
(A) 
IN
GENERAL.—Section 
1859(b)(6)(B)(iii) of the Social Security Act (42 
U.S.C. 1395w–28(b)(6)(B)(iii)) is amended— 
(i) by striking ‘‘who have’’ and insert-
ing ‘‘who—
330 
† HR 1892 EAS2 
‘‘(I) before January 1, 2022, 
have’’; 
(ii) in subclause (I), as added by 
clause (i), by striking the period at the end 
and inserting ‘‘; and’’; and 
(iii) by adding at the end the following 
new subclause: 
‘‘(II) on or after January 1, 2022, 
have one or more comorbid and medi-
cally complex chronic conditions that 
is life threatening or significantly lim-
its overall health or function, have a 
high risk of hospitalization or other 
adverse health outcomes, and require 
intensive care coordination and that is 
listed under subsection (f)(9)(A).’’. 
(B) PANEL OF CLINICAL ADVISORS.—Sec-
tion 1859(f) of the Social Security Act (42 
U.S.C. 1395w–28(f)), as amended by subsection 
(b), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION OF 
THE DEFINITION OF A SEVERE OR DISABLING CHRON-
IC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.—
331 
† HR 1892 EAS2 
‘‘(A) IN GENERAL.—Not later than Decem-
ber 31, 2020, and every 5 years thereafter, sub-
ject to subparagraphs (B) and (C), the Secretary 
shall convene a panel of clinical advisors to es-
tablish and update a list of conditions that meet 
each of the following criteria: 
‘‘(i) Conditions that meet the defini-
tion of a severe or disabling chronic condi-
tion under subsection (b)(6)(B)(iii) on or 
after January 1, 2022. 
‘‘(ii) Conditions that require prescrip-
tion drugs, providers, and models of care 
that are unique to the specific population of 
enrollees in a specialized MA plan for spe-
cial needs individuals described in such sub-
section on or after such date and— 
‘‘(I) as a result of access to, and 
enrollment in, such a specialized MA 
plan for special needs individuals, in-
dividuals with such condition would 
have a reasonable expectation of slow-
ing or halting the progression of the 
disease, improving health outcomes and 
decreasing overall costs for individuals 
diagnosed with such condition com-
332 
† HR 1892 EAS2 
pared to available options of care other 
than through such a specialized MA 
plan for special needs individuals; or 
‘‘(II) have a low prevalence in the 
general population of beneficiaries 
under this title or a disproportionally 
high per-beneficiary cost under this 
title. 
‘‘(B) INCLUSION OF CERTAIN CONDITIONS.— 
The conditions listed under subparagraph (A) 
shall include HIV/AIDS, end stage renal disease, 
and chronic and disabling mental illness. 
‘‘(C) REQUIREMENT.—In establishing and 
updating the list under subparagraph (A), the 
panel shall take into account the availability of 
varied benefits, cost-sharing, and supplemental 
benefits under the model described in paragraph 
(2) of section 1859(h), including the expansion 
under paragraph (1) of such section.’’. 
(d) QUALITY MEASUREMENT AT THE PLAN LEVEL FOR 
SNPS AND DETERMINATION OF FEASABILITY OF QUALITY 
MEASUREMENT
AT
THE
PLAN
LEVEL
FOR
ALL
MA 
PLANS.—Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w–23(o)) is amended by adding at the end the 
following new paragraphs:
333 
† HR 1892 EAS2 
‘‘(6) QUALITY
MEASUREMENT
AT
THE
PLAN 
LEVEL FOR SNPS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary may require reporting 
of data under section 1852(e) for, and apply 
under this subsection, quality measures at the 
plan level for specialized MA plans for special 
needs individuals instead of at the contract level. 
‘‘(B) CONSIDERATIONS.—Prior to applying 
quality measurement at the plan level under this 
paragraph, the Secretary shall— 
‘‘(i) take into consideration the min-
imum number of enrollees in a specialized 
MA plan for special needs individuals in 
order to determine if a statistically signifi-
cant or valid measurement of quality at the 
plan level is possible under this paragraph; 
‘‘(ii) take into consideration the im-
pact of such application on plans that serve 
a disproportionate number of individuals 
dually eligible for benefits under this title 
and under title XIX; 
‘‘(iii) if quality measures are reported 
at the plan level, ensure that MA plans are
334 
† HR 1892 EAS2 
not required to provide duplicative informa-
tion; and 
‘‘(iv) ensure that such reporting does 
not interfere with the collection of encounter 
data submitted by MA organizations or the 
administration of any changes to the pro-
gram under this part as a result of the col-
lection of such data. 
‘‘(C) APPLICATION.—If the Secretary ap-
plies quality measurement at the plan level 
under this paragraph— 
‘‘(i) such quality measurement may in-
clude Medicare Health Outcomes Survey 
(HOS), Healthcare Effectiveness Data and 
Information Set (HEDIS), Consumer As-
sessment of Healthcare Providers and Sys-
tems (CAHPS) measures and quality meas-
ures under part D; and 
‘‘(ii) the Secretary shall consider ap-
plying administrative actions, such as rem-
edies described in section 1857(g)(2), at the 
plan level. 
‘‘(7) DETERMINATION OF FEASIBILITY OF QUAL-
ITY MEASUREMENT AT THE PLAN LEVEL FOR ALL MA 
PLANS.—
335 
† HR 1892 EAS2 
‘‘(A) DETERMINATION
OF
FEASIBILITY.— 
The Secretary shall determine the feasibility of 
requiring reporting of data under section 1852(e) 
for, and applying under this subsection, quality 
measures at the plan level for all MA plans 
under this part. 
‘‘(B) CONSIDERATION
OF
CHANGE.—After 
making a determination under subparagraph 
(A), the Secretary shall consider requiring such 
reporting and applying such quality measures at 
the plan level as described in such subpara-
graph’’. 
(e) GAO STUDY AND REPORT ON STATE-LEVEL INTE-
GRATION BETWEEN DUAL SNPS AND MEDICAID.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on 
State-level integration between specialized MA plans 
for special needs individuals described in subsection 
(b)(6) (B)(ii) of section 1859 of the Social Security 
Act (42 U.S.C. 1395w–28) and the Medicaid program 
under title XIX of such Act (42 U.S.C. 1396 et seq.). 
Such study shall include an analysis of the following: 
(A) The characteristics of States in which 
the State agency responsible for administering
336 
† HR 1892 EAS2 
the State plan under such title XIX has a con-
tract with such a specialized MA plan and that 
delivers long-term services and supports under 
the State plan under such title XIX through a 
managed care program, including the require-
ments under such State plan with respect to 
long-term services and supports. 
(B) The types of such specialized MA plans, 
which may include the following: 
(i) 
A 
plan 
described 
in 
section 
1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
1395w–23(a)(1)(B)(iv)(II)). 
(ii) A plan that meets the requirements 
described in subsection (f)(3)(D) of such sec-
tion 1859. 
(iii) A plan described in clause (ii) 
that also meets additional requirements es-
tablished by the State. 
(C) The characteristics of individuals en-
rolled in such specialized MA plans. 
(D) As practicable, the following with re-
spect to State programs for the delivery of long- 
term services and supports under such title XIX 
through a managed care program:
337 
† HR 1892 EAS2 
(i) Which populations of individuals 
are eligible to receive such services and sup-
ports. 
(ii) Whether all such services and sup-
ports are provided on a capitated basis or 
if any of such services and supports are 
carved out and provided through fee-for 
service. 
(E) As practicable, how the availability and 
variation of integration arrangements of such 
specialized MA plans offered in States affects 
spending, service delivery options, access to com-
munity-based care, and utilization of care. 
(F) The efforts of State Medicaid programs 
to transition dually-eligible beneficiaries receiv-
ing long-term services and supports (LTSS) 
from institutional settings to home and commu-
nity-based settings and related financial impacts 
of such transitions. 
(G) Barriers and opportunities for making 
further progress on dual integration, as well as 
recommendations for legislation or administra-
tive action to expedite or refine pathways toward 
fully integrated care.
338 
† HR 1892 EAS2 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
Subtitle C—Expanding Innovation 
and Technology 
SEC. 50321. ADAPTING BENEFITS TO MEET THE NEEDS OF 
CHRONICALLY ILL MEDICARE ADVANTAGE 
ENROLLEES. 
Section 1859 of the Social Security Act (42 U.S.C. 
1395w–28) is amended by adding at the end the following 
new subsection: 
‘‘(h) NATIONAL TESTING OF MEDICARE ADVANTAGE 
VALUE-BASED INSURANCE DESIGN MODEL.— 
‘‘(1) IN GENERAL.—In implementing the Medi-
care Advantage Value-Based Insurance Design model 
that is being tested under section 1115A(b), the Sec-
retary shall revise the testing of the model under such 
section to cover, effective not later than January 1, 
2020, all States. 
‘‘(2) TERMINATION
AND
MODIFICATION
PROVI-
SION NOT APPLICABLE UNTIL JANUARY 1, 2022.—The
339 
† HR 1892 EAS2 
provisions of section 1115A(b)(3)(B) shall apply to 
the Medicare Advantage Value-Based Insurance De-
sign model, including such model as revised under 
paragraph (1), beginning January 1, 2022, but shall 
not apply to such model, as so revised, prior to such 
date. 
‘‘(3) FUNDING.—The Secretary shall allocate 
funds made available under section 1115A(f)(1) to de-
sign, implement, and evaluate the Medicare Advan-
tage Value-Based Insurance Design model, as revised 
under paragraph (1).’’. 
SEC. 50322. EXPANDING SUPPLEMENTAL BENEFITS TO 
MEET THE NEEDS OF CHRONICALLY ILL 
MEDICARE ADVANTAGE ENROLLEES. 
(a) IN GENERAL.—Section 1852(a)(3) of the Social Se-
curity Act (42 U.S.C. 1395w–22(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘Each’’ 
and inserting ‘‘Subject to subparagraph (D), each’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) EXPANDING SUPPLEMENTAL BENEFITS 
TO MEET THE NEEDS OF CHRONICALLY ILL EN-
ROLLEES.—
340 
† HR 1892 EAS2 
‘‘(i) IN GENERAL.—For plan year 2020 
and subsequent plan years, in addition to 
any supplemental health care benefits other-
wise provided under this paragraph, an MA 
plan, including a specialized MA plan for 
special needs individuals (as defined in sec-
tion 1859(b)(6)), may provide supplemental 
benefits described in clause (ii) to a chron-
ically ill enrollee (as defined in clause (iii)). 
‘‘(ii) SUPPLEMENTAL
BENEFITS
DE-
SCRIBED.— 
‘‘(I) IN GENERAL.—Supplemental 
benefits described in this clause are 
supplemental benefits that, with respect 
to a chronically ill enrollee, have a rea-
sonable expectation of improving or 
maintaining the health or overall func-
tion of the chronically ill enrollee and 
may not be limited to being primarily 
health related benefits. 
‘‘(II) AUTHORITY TO WAIVE UNI-
FORMITY
REQUIREMENTS.—The Sec-
retary may, only with respect to sup-
plemental benefits provided to a chron-
ically ill enrollee under this subpara-
341 
† HR 1892 EAS2 
graph, waive the uniformity require-
ments under this part, as determined 
appropriate by the Secretary. 
‘‘(iii) CHRONICALLY
ILL
ENROLLEE 
DEFINED.—In this subparagraph, the term 
‘chronically ill enrollee’ means an enrollee 
in an MA plan that the Secretary deter-
mines— 
‘‘(I) has one or more comorbid 
and medically complex chronic condi-
tions that is life threatening or signifi-
cantly limits the overall health or func-
tion of the enrollee; 
‘‘(II) has a high risk of hos-
pitalization or other adverse health 
outcomes; and 
‘‘(III) requires intensive care co-
ordination.’’. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on sup-
plemental benefits provided to enrollees in Medicare 
Advantage plans under part C of title XVIII of the 
Social Security Act, including specialized MA plans
342 
† HR 1892 EAS2 
for special needs individuals (as defined in section 
1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))). 
To the extend data are available, such study shall in-
clude an analysis of the following: 
(A) The type of supplemental benefits pro-
vided to such enrollees, the total number of en-
rollees receiving each supplemental benefit, and 
whether the supplemental benefit is covered by 
the standard benchmark cost of the benefit or 
with an additional premium. 
(B) The frequency in which supplemental 
benefits are utilized by such enrollees. 
(C) The impact supplemental benefits have 
on— 
(i) indicators of the quality of care re-
ceived by such enrollees, including overall 
health and function of the enrollees; 
(ii) the utilization of items and serv-
ices for which benefits are available under 
the original Medicare fee-for-service pro-
gram option under parts A and B of such 
title XVIII by such enrollees; and 
(iii) the amount of the bids submitted 
by Medicare Advantage Organizations for
343 
† HR 1892 EAS2 
Medicare Advantage plans under such part 
C. 
(2) CONSULTATION.—In conducting the study 
under paragraph (1), the Comptroller General shall, 
as necessary, consult with the Centers for Medicare & 
Medicaid Services and Medicare Advantage organiza-
tions offering Medicare Advantage plans. 
(3) REPORT.—Not later than 5 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
SEC. 50323. INCREASING CONVENIENCE FOR MEDICARE AD-
VANTAGE 
ENROLLEES 
THROUGH 
TELE-
HEALTH. 
(a) IN GENERAL.—Section 1852 of the Social Security 
Act (42 U.S.C. 1395w–22) is amended— 
(1) in subsection (a)(1)(B)(i), by inserting ‘‘, 
subject to subsection (m),’’ after ‘‘means’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH BENE-
FITS.—
344 
† HR 1892 EAS2 
‘‘(1) MA PLAN
OPTION.—For plan year 2020 
and subsequent plan years, subject to the requirements 
of paragraph (3), an MA plan may provide addi-
tional telehealth benefits (as defined in paragraph 
(2)) to individuals enrolled under this part. 
‘‘(2) ADDITIONAL
TELEHEALTH
BENEFITS
DE-
FINED.— 
‘‘(A) IN
GENERAL.—For purposes of this 
subsection and section 1854: 
‘‘(i) DEFINITION.—The term ‘addi-
tional telehealth benefits’ means services— 
‘‘(I) for which benefits are avail-
able under part B, including services 
for which payment is not made under 
section 1834(m) due to the conditions 
for payment under such section; and 
‘‘(II) that are identified for such 
year as clinically appropriate to fur-
nish using electronic information and 
telecommunications technology when a 
physician 
(as 
defined 
in 
section 
1861(r)) or practitioner (described in 
section 1842(b)(18)(C)) providing the 
service is not at the same location as 
the plan enrollee.
345 
† HR 1892 EAS2 
‘‘(ii) EXCLUSION OF CAPITAL AND IN-
FRASTRUCTURE
COSTS
AND
INVEST-
MENTS.—The term ‘additional telehealth 
benefits’ does not include capital and infra-
structure costs and investments relating to 
such benefits. 
‘‘(B) PUBLIC
COMMENT.—Not later than 
November 30, 2018, the Secretary shall solicit 
comments on— 
‘‘(i) what types of items and services 
(including those provided through supple-
mental health care benefits, such as remote 
patient monitoring, secure messaging, store 
and forward technologies, and other non- 
face-to-face communication) should be con-
sidered to be additional telehealth benefits; 
and 
‘‘(ii) the requirements for the provision 
or furnishing of such benefits (such as 
training and coordination requirements). 
‘‘(3) REQUIREMENTS
FOR
ADDITIONAL
TELE-
HEALTH BENEFITS.—The Secretary shall specify re-
quirements for the provision or furnishing of addi-
tional telehealth benefits, including with respect to the 
following:
346 
† HR 1892 EAS2 
‘‘(A) Physician or practitioner qualifica-
tions (other than licensure) and other require-
ments such as specific training. 
‘‘(B) Factors necessary for the coordination 
of such benefits with other items and services in-
cluding those furnished in-person. 
‘‘(C) Such other areas as determined by the 
Secretary. 
‘‘(4) ENROLLEE CHOICE.—If an MA plan pro-
vides a service as an additional telehealth benefit (as 
defined in paragraph (2))— 
‘‘(A) the MA plan shall also provide access 
to such benefit through an in-person visit (and 
not only as an additional telehealth benefit); and 
‘‘(B) an individual enrollee shall have dis-
cretion as to whether to receive such service 
through the in-person visit or as an additional 
telehealth benefit. 
‘‘(5) TREATMENT UNDER MA.—For purposes of 
this subsection and section 1854, if a plan provides 
additional telehealth benefits, such additional tele-
health benefits shall be treated as if they were benefits 
under the original Medicare fee-for-service program 
option.
347 
† HR 1892 EAS2 
‘‘(6) CONSTRUCTION.—Nothing in this subsection 
shall be construed as affecting the requirement under 
subsection (a)(1) that MA plans provide enrollees 
with items and services (other than hospice care) for 
which benefits are available under parts A and B, in-
cluding benefits available under section 1834(m).’’. 
(b) CLARIFICATION REGARDING INCLUSION
IN BID 
AMOUNT.—Section 1854(a)(6)(A)(ii)(I) of the Social Secu-
rity Act (42 U.S.C. 1395w–24(a)(6)(A)(ii)(I)) is amended 
by inserting ‘‘, including, for plan year 2020 and subse-
quent plan years, the provision of additional telehealth ben-
efits as described in section 1852(m)’’ before the semicolon 
at the end. 
SEC. 50324. PROVIDING ACCOUNTABLE CARE ORGANIZA-
TIONS THE ABILITY TO EXPAND THE USE OF 
TELEHEALTH. 
(a) IN GENERAL.—Section 1899 of the Social Security 
Act (42 U.S.C. 1395jjj) is amended by adding at the end 
the following new subsection: 
‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND THE 
USE OF TELEHEALTH SERVICES.— 
‘‘(1) IN GENERAL.—In the case of telehealth serv-
ices for which payment would otherwise be made 
under this title furnished on or after January 1, 
2020, for purposes of this subsection only, the fol-
348 
† HR 1892 EAS2 
lowing shall apply with respect to such services fur-
nished by a physician or practitioner participating 
in an applicable ACO (as defined in paragraph (2)) 
to a Medicare fee-for-service beneficiary assigned to 
the applicable ACO: 
‘‘(A) INCLUSION OF HOME AS ORIGINATING 
SITE.—Subject to paragraph (3), the home of a 
beneficiary shall be treated as an originating site 
described in section 1834(m)(4)(C)(ii). 
‘‘(B) NO APPLICATION OF GEOGRAPHIC LIM-
ITATION.—The geographic limitation under sec-
tion 1834(m)(4)(C)(i) shall not apply with re-
spect to an originating site described in section 
1834(m)(4)(C)(ii) (including the home of a bene-
ficiary under subparagraph (A)), subject to State 
licensing requirements. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE ACO.—The term ‘applica-
ble ACO’ means an ACO participating in a 
model tested or expanded under section 1115A or 
under this section— 
‘‘(i) that operates under a two-sided 
model—
349 
† HR 1892 EAS2 
‘‘(I) 
described 
in 
section 
425.600(a) of title 42, Code of Federal 
Regulations; or 
‘‘(II) tested or expanded under 
section 1115A; and 
‘‘(ii) for which Medicare fee-for-service 
beneficiaries are assigned to the ACO using 
a prospective assignment method, as deter-
mined appropriate by the Secretary. 
‘‘(B) HOME.—The term ‘home’ means, with 
respect to a Medicare fee-for-service beneficiary, 
the place of residence used as the home of the 
beneficiary. 
‘‘(3) TELEHEALTH SERVICES RECEIVED IN THE 
HOME.—In the case of telehealth services described in 
paragraph (1) where the home of a Medicare fee-for- 
service beneficiary is the originating site, the fol-
lowing shall apply: 
‘‘(A) NO FACILITY FEE.—There shall be no 
facility fee paid to the originating site under sec-
tion 1834(m)(2)(B). 
‘‘(B) EXCLUSION OF CERTAIN SERVICES.— 
No payment may be made for such services that 
are inappropriate to furnish in the home setting
350 
† HR 1892 EAS2 
such as services that are typically furnished in 
inpatient settings such as a hospital.’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Secretary of Health 
and Human Services (in this subsection referred 
to as the ‘‘Secretary’’) shall conduct a study on 
the implementation of section 1899(l) of the So-
cial Security Act, as added by subsection (a). 
Such study shall include an analysis of the utili-
zation of, and expenditures for, telehealth serv-
ices under such section. 
(B) COLLECTION OF DATA.—The Secretary 
may collect such data as the Secretary deter-
mines necessary to carry out the study under 
this paragraph. 
(2) REPORT.—Not later than January 1, 2026, 
the Secretary shall submit to Congress a report con-
taining the results of the study conducted under para-
graph (1), together with recommendations for such 
legislation and administrative action as the Secretary 
determines appropriate.
351 
† HR 1892 EAS2 
SEC. 50325. EXPANDING THE USE OF TELEHEALTH FOR IN-
DIVIDUALS WITH STROKE. 
Section 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)), as amended by section 50302(b)(1), is amend-
ed— 
(1) in paragraph (4)(C)(i), in the matter pre-
ceding subclause (I), by striking ‘‘The term’’ and in-
serting ‘‘Except as provided in paragraph (6), the 
term’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(6) TREATMENT
OF
STROKE
TELEHEALTH 
SERVICES.— 
‘‘(A) NON-APPLICATION
OF
ORIGINATING 
SITE
REQUIREMENTS.—The requirements de-
scribed in paragraph (4)(C) shall not apply with 
respect to telehealth services furnished on or after 
January 1, 2019, for purposes of diagnosis, eval-
uation, or treatment of symptoms of an acute 
stroke, as determined by the Secretary. 
‘‘(B) INCLUSION OF CERTAIN SITES.—With 
respect to telehealth services described in sub-
paragraph (A), the term ‘originating site’ shall 
include any hospital (as defined in section 
1861(e)) or critical access hospital (as defined in 
section 1861(mm)(1)), any mobile stroke unit (as
352 
† HR 1892 EAS2 
defined by the Secretary), or any other site deter-
mined appropriate by the Secretary, at which 
the eligible telehealth individual is located at the 
time the service is furnished via a telecommuni-
cations system. 
‘‘(C) NO ORIGINATING SITE FACILITY FEE 
FOR NEW SITES.—No facility fee shall be paid 
under paragraph (2)(B) to an originating site 
with respect to a telehealth service described in 
subparagraph (A) if the originating site does not 
otherwise meet the requirements for an origi-
nating site under paragraph (4)(C).’’. 
Subtitle D—Identifying the 
Chronically Ill Population 
SEC. 50331. PROVIDING FLEXIBILITY FOR BENEFICIARIES 
TO BE PART OF AN ACCOUNTABLE CARE OR-
GANIZATION. 
Section 1899(c) of the Social Security Act (42 U.S.C. 
1395jjj(c)) is amended— 
(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and indent-
ing appropriately; 
(2) by striking ‘‘ACOS.—The Secretary’’ and in-
serting ‘‘ACOS.—
353 
† HR 1892 EAS2 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the 
Secretary’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(2) PROVIDING FLEXIBILITY.— 
‘‘(A) CHOICE
OF
PROSPECTIVE
ASSIGN-
MENT.—For each agreement period (effective for 
agreements entered into or renewed on or after 
January 1, 2020), in the case where an ACO es-
tablished under the program is in a Track that 
provides for the retrospective assignment of 
Medicare fee-for-service beneficiaries to the ACO, 
the Secretary shall permit the ACO to choose to 
have Medicare fee-for-service beneficiaries as-
signed prospectively, rather than retrospectively, 
to the ACO for an agreement period. 
‘‘(B) ASSIGNMENT
BASED
ON
VOLUNTARY 
IDENTIFICATION BY MEDICARE FEE-FOR-SERVICE 
BENEFICIARIES.— 
‘‘(i) IN
GENERAL.—For performance 
year 2018 and each subsequent performance 
year, if a system is available for electronic 
designation, the Secretary shall permit a 
Medicare fee-for-service beneficiary to volun-
tarily identify an ACO professional as the
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† HR 1892 EAS2 
primary care provider of the beneficiary for 
purposes of assigning such beneficiary to an 
ACO, as determined by the Secretary. 
‘‘(ii) 
NOTIFICATION
PROCESS.—The 
Secretary shall establish a process under 
which a Medicare fee-for-service beneficiary 
is— 
‘‘(I) notified of their ability to 
make an identification described in 
clause (i); and 
‘‘(II) informed of the process by 
which they may make and change such 
identification. 
‘‘(iii) SUPERSEDING CLAIMS-BASED AS-
SIGNMENT.—A voluntary identification by 
a Medicare fee-for-service beneficiary under 
this subparagraph shall supersede any 
claims-based assignment otherwise deter-
mined by the Secretary.’’.
355 
† HR 1892 EAS2 
Subtitle 
E—Empowering 
Individ-
uals and Caregivers in Care De-
livery 
SEC. 50341. ELIMINATING BARRIERS TO CARE COORDINA-
TION UNDER ACCOUNTABLE CARE ORGANIZA-
TIONS. 
(a) IN GENERAL.—Section 1899 of the Social Security 
Act (42 U.S.C. 1395jjj), as amended by section 50324(a), 
is amended— 
(1) in subsection (b)(2), by adding at the end the 
following new subparagraph: 
‘‘(I) An ACO that seeks to operate an ACO 
Beneficiary Incentive Program pursuant to sub-
section (m) shall apply to the Secretary at such 
time, in such manner, and with such informa-
tion as the Secretary may require.’’; 
(2) by adding at the end the following new sub-
section: 
‘‘(m) AUTHORITY TO PROVIDE INCENTIVE PAYMENTS 
TO BENEFICIARIES WITH RESPECT TO QUALIFYING PRI-
MARY CARE SERVICES.— 
‘‘(1) PROGRAM.— 
‘‘(A) IN GENERAL.—In order to encourage 
Medicare fee-for-service beneficiaries to obtain 
medically necessary primary care services, an
356 
† HR 1892 EAS2 
ACO participating under this section under a 
payment model described in clause (i) or (ii) of 
paragraph (2)(B) may apply to establish an 
ACO Beneficiary Incentive Program to provide 
incentive payments to such beneficiaries who are 
furnished qualifying services in accordance with 
this subsection. The Secretary shall permit such 
an ACO to establish such a program at the Sec-
retary’s discretion and subject to such require-
ments, including program integrity require-
ments, as the Secretary determines necessary. 
‘‘(B) 
IMPLEMENTATION.—The 
Secretary 
shall implement this subsection on a date deter-
mined appropriate by the Secretary. Such date 
shall be no earlier than January 1, 2019, and no 
later than January 1, 2020. 
‘‘(2) CONDUCT OF PROGRAM.— 
‘‘(A) DURATION.—Subject to subparagraph 
(H), an ACO Beneficiary Incentive Program es-
tablished under this subsection shall be conducted 
for such period (of not less than 1 year) as the 
Secretary may approve. 
‘‘(B) SCOPE.—An ACO Beneficiary Incen-
tive Program established under this subsection 
shall provide incentive payments to all of the fol-
357 
† HR 1892 EAS2 
lowing Medicare fee-for-service beneficiaries who 
are furnished qualifying services by the ACO: 
‘‘(i) With respect to the Track 2 and 
Track 3 payment models described in sec-
tion 425.600(a) of title 42, Code of Federal 
Regulations (or in any successor regula-
tion), Medicare fee-for-service beneficiaries 
who are preliminarily prospectively or pro-
spectively assigned (or otherwise assigned, 
as determined by the Secretary) to the ACO. 
‘‘(ii) With respect to any future pay-
ment models involving two-sided risk, Medi-
care fee-for-service beneficiaries who are as-
signed to the ACO, as determined by the 
Secretary. 
‘‘(C) QUALIFYING SERVICE.—For purposes 
of this subsection, a qualifying service is a pri-
mary care service, as defined in section 425.20 
of title 42, Code of Federal Regulations (or in 
any successor regulation), with respect to which 
coinsurance applies under part B, furnished 
through an ACO by— 
‘‘(i) an ACO professional described in 
subsection (h)(1)(A) who has a primary 
care specialty designation included in the
358 
† HR 1892 EAS2 
definition of primary care physician under 
section 425.20 of title 42, Code of Federal 
Regulations (or any successor regulation); 
‘‘(ii) an ACO professional described in 
subsection (h)(1)(B); or 
‘‘(iii) a Federally qualified health cen-
ter or rural health clinic (as such terms are 
defined in section 1861(aa)). 
‘‘(D) INCENTIVE PAYMENTS.—An incentive 
payment made by an ACO pursuant to an ACO 
Beneficiary Incentive Program established under 
this subsection shall be— 
‘‘(i) in an amount up to $20, with 
such maximum amount updated annually 
by the percentage increase in the consumer 
price index for all urban consumers (United 
States city average) for the 12-month period 
ending with June of the previous year; 
‘‘(ii) in the same amount for each 
Medicare fee-for-service beneficiary described 
in clause (i) or (ii) of subparagraph (B) 
without regard to enrollment of such a bene-
ficiary in a medicare supplemental policy 
(described in section 1882(g)(1)), in a State 
Medicaid plan under title XIX or a waiver
359 
† HR 1892 EAS2 
of such a plan, or in any other health in-
surance policy or health benefit plan; 
‘‘(iii) made for each qualifying service 
furnished to such a beneficiary described in 
clause (i) or (ii) of subparagraph (B) dur-
ing a period specified by the Secretary; and 
‘‘(iv) made no later than 30 days after 
a qualifying service is furnished to such a 
beneficiary described in clause (i) or (ii) of 
subparagraph (B). 
‘‘(E) NO SEPARATE PAYMENTS FROM THE 
SECRETARY.—The Secretary shall not make any 
separate payment to an ACO for the costs, in-
cluding incentive payments, of carrying out an 
ACO Beneficiary Incentive Program established 
under this subsection. Nothing in this subpara-
graph shall be construed as prohibiting an ACO 
from using shared savings received under this 
section to carry out an ACO Beneficiary Incen-
tive Program. 
‘‘(F) NO APPLICATION TO SHARED SAVINGS 
CALCULATION.—Incentive payments made by an 
ACO under this subsection shall be disregarded 
for purposes of calculating benchmarks, esti-
360 
† HR 1892 EAS2 
mated average per capita Medicare expenditures, 
and shared savings under this section. 
‘‘(G) 
REPORTING
REQUIREMENTS.—An 
ACO conducting an ACO Beneficiary Incentive 
Program under this subsection shall, at such 
times and in such format as the Secretary may 
require, report to the Secretary such information 
and retain such documentation as the Secretary 
may require, including the amount and fre-
quency of incentive payments made and the 
number of Medicare fee-for-service beneficiaries 
receiving such payments. 
‘‘(H) TERMINATION.—The Secretary may 
terminate an ACO Beneficiary Incentive Pro-
gram established under this subsection at any 
time for reasons determined appropriate by the 
Secretary. 
‘‘(3) EXCLUSION OF INCENTIVE PAYMENTS.—Any 
payment made under an ACO Beneficiary Incentive 
Program established under this subsection shall not be 
considered income or resources or otherwise taken into 
account for purposes of— 
‘‘(A) determining eligibility for benefits or 
assistance (or the amount or extent of benefits or 
assistance) under any Federal program or under
361 
† HR 1892 EAS2 
any State or local program financed in whole or 
in part with Federal funds; or 
‘‘(B) any Federal or State laws relating to 
taxation.’’; 
(3) in subsection (e), by inserting ‘‘, including 
an ACO Beneficiary Incentive Program under sub-
sections (b)(2)(I) and (m)’’ after ‘‘the program’’; and 
(4) in subsection (g)(6), by inserting ‘‘or of an 
ACO Beneficiary Incentive Program under sub-
sections (b)(2)(I) and (m)’’ after ‘‘under subsection 
(d)(4)’’. 
(b) 
AMENDMENT
TO
SECTION
1128B.—Section 
1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a– 
7b(b)(3)) is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (I); 
(2) by striking the period at the end of subpara-
graph (J) and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(K) an incentive payment made to a Medi-
care fee-for-service beneficiary by an ACO under 
an ACO Beneficiary Incentive Program estab-
lished under subsection (m) of section 1899, if 
the payment is made in accordance with the re-
362 
† HR 1892 EAS2 
quirements of such subsection and meets such 
other conditions as the Secretary may estab-
lish.’’. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary of Health and 
Human Services (in this subsection referred to as the 
‘‘Secretary’’) shall conduct an evaluation of the ACO 
Beneficiary Incentive Program established under sub-
sections (b)(2)(I) and (m) of section 1899 of the So-
cial Security Act (42 U.S.C. 1395jjj), as added by 
subsection (a). The evaluation shall include an anal-
ysis of the impact of the implementation of the Pro-
gram on expenditures and beneficiary health outcomes 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). 
(2) REPORT.—Not later than October 1, 2023, 
the Secretary shall submit to Congress a report con-
taining the results of the evaluation under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Secretary deter-
mines appropriate.
363 
† HR 1892 EAS2 
SEC. 50342. GAO STUDY AND REPORT ON LONGITUDINAL 
COMPREHENSIVE CARE PLANNING SERVICES 
UNDER MEDICARE PART B. 
(a) STUDY.—The Comptroller General shall conduct a 
study on the establishment under part B of the Medicare 
program under title XVIII of the Social Security Act of 
a payment code for a visit for longitudinal comprehensive 
care planning services. Such study shall include an anal-
ysis of the following to the extent such information is avail-
able: 
(1) The frequency with which services similar to 
longitudinal comprehensive care planning services are 
furnished to Medicare beneficiaries, which providers 
of services and suppliers are furnishing those services, 
whether Medicare reimbursement is being received for 
those services, and, if so, through which codes those 
services are being reimbursed. 
(2) Whether, and the extent to which, longitu-
dinal comprehensive care planning services would 
overlap, and could therefore result in duplicative pay-
ment, with services covered under the hospice benefit 
as well as the chronic care management code, evalua-
tion and management codes, or other codes that al-
ready exist under part B of the Medicare program. 
(3) Any barriers to hospitals, skilled nursing fa-
cilities, hospice programs, home health agencies, and
364 
† HR 1892 EAS2 
other applicable providers working with a Medicare 
beneficiary to engage in the care planning process 
and complete the necessary documentation to support 
the treatment and care plan of the beneficiary and 
provide such documentation to other providers and 
the beneficiary or the beneficiary’s representative. 
(4) Any barriers to providers, other than the pro-
vider furnishing longitudinal comprehensive care 
planning services, accessing the care plan and associ-
ated documentation for use related to the care of the 
Medicare beneficiary. 
(5) Potential options for ensuring that applica-
ble providers are notified of a patient’s existing longi-
tudinal care plan and that applicable providers con-
sider that plan in making their treatment decisions, 
and what the challenges might be in implementing 
such options. 
(6) Stakeholder’s views on the need for the devel-
opment of quality metrics with respect to longitudinal 
comprehensive care planning services, such as meas-
ures related to— 
(A) the process of eliciting input from the 
Medicare beneficiary or from a legally author-
ized representative and documenting in the med-
ical record the patient-directed care plan;
365 
† HR 1892 EAS2 
(B) 
the 
effectiveness 
and 
patient- 
centeredness of the care plan in organizing deliv-
ery of services consistent with the plan; 
(C) the availability of the care plan and as-
sociated documentation to other providers that 
care for the beneficiary; and 
(D) the extent to which the beneficiary re-
ceived services and support that is free from dis-
crimination based on advanced age, disability 
status, or advanced illness. 
(7) Stakeholder’s views on how such quality 
metrics would provide information on— 
(A) the goals, values, and preferences of the 
beneficiary; 
(B) the documentation of the care plan; 
(C) services furnished to the beneficiary; 
and 
(D) outcomes of treatment. 
(8) Stakeholder’s views on— 
(A) the type of training and education 
needed for applicable providers, individuals, and 
caregivers in order to facilitate longitudinal 
comprehensive care planning services;
366 
† HR 1892 EAS2 
(B) the types of providers of services and 
suppliers that should be included in the inter-
disciplinary team of an applicable provider; and 
(C) the characteristics of Medicare bene-
ficiaries that would be most appropriate to re-
ceive longitudinal comprehensive care planning 
services, such as individuals with advanced dis-
ease and individuals who need assistance with 
multiple activities of daily living. 
(9) Stakeholder’s views on the frequency with 
which longitudinal comprehensive care planning serv-
ices should be furnished. 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the 
study conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Comptroller General determines appropriate. 
(c) DEFINITIONS.—In this section: 
(1) APPLICABLE PROVIDER.—The term ‘‘applica-
ble provider’’ means a hospice program (as defined in 
subsection (dd)(2) of section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395ww)) or other provider of 
services (as defined in subsection (u) of such section)
367 
† HR 1892 EAS2 
or supplier (as defined in subsection (d) of such sec-
tion) that— 
(A) furnishes longitudinal comprehensive 
care planning services through an interdiscipli-
nary team; and 
(B) meets such other requirements as the 
Secretary may determine to be appropriate. 
(2) COMPTROLLER GENERAL.—The term ‘‘Comp-
troller General’’ means the Comptroller General of the 
United States. 
(3) 
INTERDISCIPLINARY
TEAM.—The 
term 
‘‘interdisciplinary team’’ means a group that— 
(A) includes the personnel described in sub-
section (dd)(2)(B)(i) of such section 1861; 
(B) may include a chaplain, minister, or 
other clergy; and 
(C) may include other direct care personnel. 
(4) LONGITUDINAL COMPREHENSIVE CARE PLAN-
NING SERVICES.—The term ‘‘longitudinal comprehen-
sive care planning services’’ means a voluntary 
shared decisionmaking process that is furnished by an 
applicable provider through an interdisciplinary 
team and includes a conversation with Medicare bene-
ficiaries who have received a diagnosis of a serious or 
life-threatening illness. The purpose of such services is
368 
† HR 1892 EAS2 
to discuss a longitudinal care plan that addresses the 
progression of the disease, treatment options, the 
goals, values, and preferences of the beneficiary, and 
the availability of other resources and social supports 
that may reduce the beneficiary’s health risks and 
promote self-management and shared decisionmaking. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
Subtitle F—Other Policies to Im-
prove Care for the Chronically 
Ill 
SEC. 50351. GAO STUDY AND REPORT ON IMPROVING MEDI-
CATION SYNCHRONIZATION. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall conduct a study on the extent to which Medicare 
prescription drug plans (MA–PD plans and stand alone 
prescription drug plans) under part D of title XVIII of the 
Social Security Act and private payors use programs that 
synchronize pharmacy dispensing so that individuals may 
receive multiple prescriptions on the same day to facilitate 
comprehensive counseling and promote medication adher-
ence. The study shall include a analysis of the following: 
(1) The extent to which pharmacies have adopted 
such programs.
369 
† HR 1892 EAS2 
(2) The common characteristics of such pro-
grams, including how pharmacies structure coun-
seling sessions under such programs and the types of 
payment and other arrangements that Medicare pre-
scription drug plans and private payors employ 
under such programs to support the efforts of phar-
macies. 
(3) How such programs compare for Medicare 
prescription drug plans and private payors. 
(4) What is known about how such programs af-
fect patient medication adherence and overall patient 
health outcomes, including if adherence and outcomes 
vary by patient subpopulations, such as disease state 
and socioeconomic status. 
(5) What is known about overall patient satisfac-
tion with such programs and satisfaction with such 
programs, including within patient subpopulations, 
such as disease state and socioeconomic status. 
(6) The extent to which laws and regulations of 
the Medicare program support such programs. 
(7) Barriers to the use of medication synchroni-
zation programs by Medicare prescription drug plans. 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the
370 
† HR 1892 EAS2 
study under subsection (a), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 50352. GAO STUDY AND REPORT ON IMPACT OF OBE-
SITY 
DRUGS 
ON 
PATIENT 
HEALTH 
AND 
SPENDING. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall, to the extent data are available, conduct a 
study on the use of prescription drugs to manage the weight 
of obese patients and the impact of coverage of such drugs 
on patient health and on health care spending. Such study 
shall examine the use and impact of these obesity drugs in 
the non-Medicare population and for Medicare beneficiaries 
who have such drugs covered through an MA–PD plan (as 
defined in section 1860D–1(a)(3)(C) of the Social Security 
Act (42 U.S.C. 1395w–101(a)(3)(C))) as a supplemental 
health care benefit. The study shall include an analysis of 
the following: 
(1) The prevalence of obesity in the Medicare 
and non-Medicare population. 
(2) The utilization of obesity drugs. 
(3) The distribution of Body Mass Index by in-
dividuals taking obesity drugs, to the extent prac-
ticable.
371 
† HR 1892 EAS2 
(4) What is known about the use of obesity drugs 
in conjunction with the receipt of other items or serv-
ices, such as behavioral counseling, and how these 
compare to items and services received by obese indi-
viduals who do not take obesity drugs. 
(5) Physician considerations and attitudes re-
lated to prescribing obesity drugs. 
(6) The extent to which coverage policies cease or 
limit coverage for individuals who fail to receive clin-
ical benefit. 
(7) What is known about the extent to which in-
dividuals who take obesity drugs adhere to the pre-
scribed regimen. 
(8) What is known about the extent to which in-
dividuals who take obesity drugs maintain weight loss 
over time. 
(9) What is known about the subsequent impact 
such drugs have on medical services that are directly 
related to obesity, including with respect to sub-
populations determined based on the extent of obesity. 
(10) What is known about the spending associ-
ated with the care of individuals who take obesity 
drugs, compared to the spending associated with the 
care of individuals who do not take such drugs.
372 
† HR 1892 EAS2 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the 
study under subsection (a), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 50353. HHS STUDY AND REPORT ON LONG-TERM RISK 
FACTORS FOR CHRONIC CONDITIONS AMONG 
MEDICARE BENEFICIARIES. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall 
conduct a study on long-term cost drivers to the Medicare 
program, including obesity, tobacco use, mental health con-
ditions, and other factors that may contribute to the deterio-
ration of health conditions among individuals with chronic 
conditions in the Medicare population. The study shall in-
clude an analysis of any barriers to collecting and ana-
lyzing such information and how to remove any such bar-
riers (including through legislation and administrative ac-
tions). 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Secretary shall submit to 
Congress a report containing the results of the study under 
subsection (a), together with recommendations for such leg-
islation and administrative action as the Secretary deter-
373 
† HR 1892 EAS2 
mines appropriate. The Secretary shall also post such re-
port on the Internet website of the Department of Health 
and Human Services. 
SEC. 50354. PROVIDING PRESCRIPTION DRUG PLANS WITH 
PARTS A AND B CLAIMS DATA TO PROMOTE 
THE APPROPRIATE USE OF MEDICATIONS 
AND IMPROVE HEALTH OUTCOMES. 
Section 1860D–4(c) of the Social Security Act (42 
U.S.C. 1395w–104(c)) is amended by adding at the end the 
following new paragraph: 
‘‘(6) PROVIDING
PRESCRIPTION
DRUG
PLANS 
WITH PARTS A AND B CLAIMS DATA TO PROMOTE THE 
APPROPRIATE
USE
OF
MEDICATIONS
AND
IMPROVE 
HEALTH OUTCOMES.— 
‘‘(A) PROCESS.—Subject to subparagraph 
(B), the Secretary shall establish a process under 
which a PDP sponsor of a prescription drug 
plan may submit a request for the Secretary to 
provide the sponsor, on a periodic basis and in 
an electronic format, beginning in plan year 
2020, data described in subparagraph (D) with 
respect to enrollees in such plan. Such data shall 
be provided without regard to whether such en-
rollees are described in clause (ii) of paragraph 
(2)(A).
374 
† HR 1892 EAS2 
‘‘(B) PURPOSES.—A PDP sponsor may use 
the data provided to the sponsor pursuant to 
subparagraph (A) for any of the following pur-
poses: 
‘‘(i) To optimize therapeutic outcomes 
through improved medication use, as such 
phrase is used in clause (i) of paragraph 
(2)(A). 
‘‘(ii) To improving care coordination 
so as to prevent adverse health outcomes, 
such as preventable emergency department 
visits and hospital readmissions. 
‘‘(iii) For any other purpose deter-
mined appropriate by the Secretary. 
‘‘(C) LIMITATIONS ON DATA USE.—A PDP 
sponsor shall not use data provided to the spon-
sor pursuant to subparagraph (A) for any of the 
following purposes: 
‘‘(i) To inform coverage determinations 
under this part. 
‘‘(ii) To conduct retroactive reviews of 
medically accepted indications determina-
tions. 
‘‘(iii) To facilitate enrollment changes 
to a different prescription drug plan or an
375 
† HR 1892 EAS2 
MA–PD plan offered by the same parent or-
ganization. 
‘‘(iv) To inform marketing of benefits. 
‘‘(v) For any other purpose that the 
Secretary determines is necessary to include 
in order to protect the identity of individ-
uals entitled to, or enrolled for, benefits 
under this title and to protect the security 
of personal health information. 
‘‘(D) DATA
DESCRIBED.—The data de-
scribed in this clause are standardized extracts 
(as determined by the Secretary) of claims data 
under parts A and B for items and services fur-
nished under such parts for time periods speci-
fied by the Secretary. Such data shall include 
data as current as practicable.’’.