IB 
Union Calendar No. 470 
114TH CONGRESS 
2D SESSION 
H. R. 5273 
[Report No. 114–604, Part I] 
To amend title XVIII of the Social Security Act to provide for regulatory 
relief under the Medicare program for certain providers of services and 
suppliers and increased transparency in hospital coding and enrollment 
data, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 18, 2016 
Mr. TIBERI (for himself and Mr. MCDERMOTT) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
JUNE 7, 2016 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
JUNE 7, 2016 
The Committee on Energy and Commerce discharged; committed to the Com-
mittee of the Whole House on the State of the Union and ordered to be 
printed 
[For text of introduced bill, see copy of bill as introduced on May 18, 2016] 
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A BILL 
To amend title XVIII of the Social Security Act to provide 
for regulatory relief under the Medicare program for 
certain providers of services and suppliers and increased 
transparency in hospital coding and enrollment data, and 
for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Helping Hospitals Improve Patient Care Act of 2016’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—PROVISIONS RELATING TO MEDICARE PART A 
Sec. 101. Development of Medicare study for HCPCS version of MS–DRG codes 
for similar hospital services. 
Sec. 102. Establishing beneficiary equity in the Medicare hospital readmission 
program. 
Sec. 103. Five-year extension of the rural community hospital demonstration pro-
gram. 
Sec. 104. Regulatory relief for LTCHs. 
Sec. 105. Savings from IPPS MACRA pay-for through not applying documenta-
tion and coding adjustments. 
TITLE II—PROVISIONS RELATING TO MEDICARE PART B 
Sec. 201. Continuing Medicare payment under HOPD prospective payment sys-
tem for services furnished by mid-build off-campus outpatient 
departments of providers. 
Sec. 202. Treatment of cancer hospitals in off-campus outpatient department of 
a provider policy. 
Sec. 203. Treatment of eligible professionals in ambulatory surgical centers for 
meaningful use and MIPS. 
TITLE III—OTHER MEDICARE PROVISIONS 
Sec. 301. Delay in authority to terminate contracts for Medicare Advantage plans 
failing to achieve minimum quality ratings. 
Sec. 302. Requirement for enrollment data reporting for Medicare. 
Sec. 303. Updating the Welcome to Medicare package. 
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TITLE I—PROVISIONS RELATING 
TO MEDICARE PART A 
SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS 
VERSION OF MS–DRG CODES FOR SIMILAR 
HOSPITAL SERVICES. 
Section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended by adding at the end the following 
new subsection: 
‘‘(t) RELATING SIMILAR INPATIENT AND OUTPATIENT 
HOSPITAL SERVICES.— 
‘‘(1) DEVELOPMENT OF HCPCS VERSION OF MS– 
DRG CODES.— 
‘‘(A) IN GENERAL.—Not later than January 
1, 2018, the Secretary shall develop HCPCS 
versions for MS–DRGs that is similar to the 
ICD–10–PCS for such MS–DRGs such that, to 
the extent possible, the MS–DRG assignment 
shall be similar for a claim coded with the 
HCPCS version as an identical claim coded with 
a ICD–10–PCS code. 
‘‘(B) COVERAGE OF SURGICAL MS–DRGS.— 
In carrying out subparagraph (A), the Secretary 
shall develop HCPCS versions of MS–DRG codes 
for not fewer than 10 surgical MS–DRGs. 
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‘‘(C) PUBLICATION AND DISSEMINATION OF 
THE HCPCS VERSIONS OF MS–DRGS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
develop a HCPCS MS–DRG definitions 
manual and software that is similar to the 
definitions manual and software for ICD– 
10–PCS codes for such MS–DRGs. The Sec-
retary shall post the HCPCS MS–DRG 
definitions manual and software on the 
Internet website of the Centers for Medicare 
& Medicaid Services. The HCPCS MS– 
DRG definitions manual and software shall 
be in the public domain and available for 
use and redistribution without charge. 
‘‘(ii) USE
OF
PREVIOUS
ANALYSIS 
DONE
BY
MEDPAC.—In developing the 
HCPCS MS–DRG definitions manual and 
software under clause (i), the Secretary 
shall consult with the Medicare Payment 
Advisory Commission and shall consider the 
analysis done by such Commission in trans-
lating outpatient surgical claims into inpa-
tient surgical MS–DRGs in preparing 
chapter 7 (relating to hospital short-stay 
policy issues) of its ‘Medicare and the 
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Health Care Delivery System’ report sub-
mitted to Congress in June 2015. 
‘‘(D) DEFINITION
AND
REFERENCE.—In 
this paragraph: 
‘‘(i) HCPCS.—The term ‘HCPCS’ 
means, with respect to hospital items and 
services, the code under the Healthcare 
Common 
Procedure 
Coding 
System 
(HCPCS) (or a successor code) for such 
items and services. 
‘‘(ii) ICD–10–PCS.—The term ‘ICD– 
10–PCS’ means the International Classi-
fication of Diseases, 10th Revision, Proce-
dure Coding System, and includes a subse-
quent revision of such International Classi-
fication of Diseases, Procedure Coding Sys-
tem.’’. 
SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE 
MEDICARE 
HOSPITAL 
READMISSION 
PRO-
GRAM. 
(a) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGIBLE 
POPULATION.—Section 1886(q)(3) of the Social Security 
Act (42 U.S.C. 1395ww(q)(3)) is amended— 
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(1) in subparagraph (A), by inserting ‘‘subject to 
subparagraph (D),’’ after ‘‘purposes of paragraph 
(1),’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) 
TRANSITIONAL
ADJUSTMENT
FOR 
DUAL ELIGIBLES.— 
‘‘(i) IN GENERAL.—In determining a 
hospital’s adjustment factor under this 
paragraph for purposes of making pay-
ments for discharges occurring during and 
after fiscal year 2019, and before the appli-
cation of clause (i) of subparagraph (E), the 
Secretary shall assign hospitals to groups 
(as defined by the Secretary under clause 
(ii)) and apply the applicable provisions of 
this subsection using a methodology in a 
manner that allows for separate comparison 
of hospitals within each such group, as de-
termined by the Secretary. 
‘‘(ii) DEFINING
GROUPS.—For pur-
poses of this subparagraph, the Secretary 
shall define groups of hospitals based on 
their overall proportion, of the inpatients 
who are entitled to, or enrolled for, benefits 
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under part A, who are full-benefit dual eli-
gible individuals (as defined in section 
1935(c)(6)). In defining groups, the Sec-
retary shall consult the Medicare Payment 
Advisory Commission and may consider the 
analysis done by such Commission in pre-
paring the portion of its report submitted to 
Congress in June 2013 relating to readmis-
sions. 
‘‘(iii) MINIMIZING REPORTING BURDEN 
ON HOSPITALS.—In carrying out this sub-
paragraph, the Secretary shall not impose 
any additional reporting requirements on 
hospitals. 
‘‘(iv) BUDGET NEUTRAL DESIGN METH-
ODOLOGY.—The Secretary shall design the 
methodology to implement this subpara-
graph so that the estimated total amount of 
reductions in payments under this sub-
section equals the estimated total amount of 
reductions in payments that would other-
wise occur under this subsection if this sub-
paragraph did not apply.’’. 
(b) SUBSEQUENT ADJUSTMENTS BASED ON IMPACT 
REPORTS.—Section 1886(q)(3) of the Social Security Act 
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(42 U.S.C. 1395ww(q)(3)), as amended by subsection (a), 
is further amended by adding at the end the following new 
subparagraph: 
‘‘(E) CHANGES IN RISK ADJUSTMENT.— 
‘‘(i) CONSIDERATION OF RECOMMENDA-
TIONS IN IMPACT REPORTS.—The Secretary 
may take into account the studies conducted 
and the recommendations made by the Sec-
retary under section 2(d)(1) of the IMPACT 
Act of 2014 (Public Law 113–185; 42 
U.S.C. 1395lll note) with respect to the ap-
plication under this subsection of risk ad-
justment methodologies. Nothing in this 
clause shall be construed as precluding con-
sideration of the use of groupings of hos-
pitals.’’. 
(c) MEDPAC STUDY ON READMISSIONS PROGRAM.— 
The Medicare Payment Advisory Commission shall conduct 
a study to review overall hospital readmissions described 
in section 1886(q)(5)(E) of the Social Security Act (42 
U.S.C. 1395ww(q)(5)(E)) and whether such readmissions 
are related to any changes in outpatient and emergency 
services furnished. The Commission shall submit to Con-
gress a report on such study in its report to Congress in 
June 2017. 
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(d) ADDRESSING ISSUE OF CERTAIN PATIENTS.—Sub-
paragraph (E) of section 1886(q)(3) of the Social Security 
Act (42 U.S.C. 1395ww(q)(3)), as added by subsection (b), 
is further amended by adding at the end the following new 
clause: 
‘‘(ii) CONSIDERATION
OF
EXCLUSION 
OF PATIENT CASES BASED ON V OR OTHER 
APPROPRIATE
CODES.—In 
promulgating 
regulations to carry out this subsection with 
respect to discharges occurring after fiscal 
year 2018, the Secretary may consider the 
use of V or other ICD-related codes for re-
moval of a readmission. The Secretary may 
consider modifying measures under this 
subsection to incorporate V or other ICD-re-
lated codes at the same time as other 
changes are being made under this subpara-
graph.’’. 
(e) REMOVAL OF CERTAIN READMISSIONS.—Subpara-
graph (E) of section 1886(q)(3) of the Social Security Act 
(42 U.S.C. 1395ww(q)(3)), as added by subsection (b) and 
amended by subsection (d), is further amended by adding 
at the end the following new clause: 
‘‘(iii) REMOVAL OF CERTAIN READMIS-
SIONS.—In promulgating regulations to 
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carry out this subsection, with respect to 
discharges occurring after fiscal year 2018, 
the Secretary may consider removal as a re-
admission of an admission that is classified 
within one or more of the following: trans-
plants, end-stage renal disease, burns, trau-
ma, psychosis, or substance abuse. The Sec-
retary may consider modifying measures 
under this subsection to remove readmis-
sions at the same time as other changes are 
being made under this subparagraph.’’. 
SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMU-
NITY HOSPITAL DEMONSTRATION PROGRAM. 
(a) EXTENSION.—Section 410A of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173; 42 U.S.C. 1395ww note), as 
amended by sections 3123 and 10313 of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148), is 
amended— 
(1) in subsection (a)(5), by striking ‘‘5-year ex-
tension period’’ and inserting ‘‘10-year extension pe-
riod’’; and 
(2) in subsection (g)— 
(A) in the subsection heading, by striking 
‘‘FIVE-YEAR’’ and inserting ‘‘TEN-YEAR’’; 
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(B) in paragraph (1), by striking ‘‘addi-
tional 5-year’’ and inserting ‘‘additional 10- 
year’’; 
(C) by striking ‘‘5-year extension period’’ 
and inserting ‘‘10-year extension period’’ each 
place it appears; 
(D) in paragraph (4)(B)— 
(i) in the matter preceding clause (i), 
by inserting ‘‘each 5-year period in’’ after 
‘‘hospital during’’; and 
(ii) in clause (i), by inserting ‘‘each 
applicable 5-year period in’’ after ‘‘the first 
day of’’; and 
(E) by adding at the end the following new 
paragraphs: 
‘‘(5) OTHER
HOSPITALS
IN
DEMONSTRATION 
PROGRAM.—During the second 5 years of the 10-year 
extension period, the Secretary shall apply the provi-
sions of paragraph (4) to rural community hospitals 
that are not described in paragraph (4) but are par-
ticipating in the demonstration program under this 
section as of December 30, 2014, in a similar manner 
as such provisions apply to rural community hos-
pitals described in paragraph (4). 
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‘‘(6) EXPANSION OF DEMONSTRATION PROGRAM 
TO RURAL AREAS IN ANY STATE.— 
‘‘(A) IN
GENERAL.—The Secretary shall, 
notwithstanding subsection (a)(2) or paragraph 
(2) of this subsection, not later than 120 days 
after the date of the enactment of this paragraph, 
issue a solicitation for applications to select up 
to the maximum number of additional rural 
community hospitals located in any State to 
participate in the demonstration program under 
this section for the second 5 years of the 10-year 
extension period without exceeding the limitation 
under paragraph (3) of this subsection. 
‘‘(B) PRIORITY.—In determining which 
rural community hospitals that submitted an 
application pursuant to the solicitation under 
subparagraph (A) to select for participation in 
the demonstration program, the Secretary— 
‘‘(i) shall give priority to rural com-
munity hospitals located in one of the 20 
States with the lowest population densities 
(as determined by the Secretary using the 
2015 Statistical Abstract of the United 
States); and 
‘‘(ii) may consider— 
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‘‘(I) closures of hospitals located 
in rural areas in the State in which 
the rural community hospital is lo-
cated during the 5-year period imme-
diately preceding the date of the enact-
ment of this paragraph; and 
‘‘(II) the population density of the 
State in which the rural community 
hospital is located.’’. 
(b) CHANGE IN TIMING FOR REPORT.—Subsection (e) 
of such section 410A is amended— 
(1) by striking ‘‘Not later than 6 months after 
the completion of the demonstration program under 
this section’’ and inserting ‘‘Not later than August 1, 
2018’’; and 
(2) by striking ‘‘such program’’ and inserting 
‘‘the demonstration program under this section’’. 
SEC. 104. REGULATORY RELIEF FOR LTCHS. 
(a) TECHNICAL CHANGE TO THE MEDICARE LONG- 
TERM CARE HOSPITAL MORATORIUM EXCEPTION.— 
(1) IN GENERAL.—Section 114(d)(7) of the Medi-
care, Medicaid, and SCHIP Extension Act of 2007 
(42 U.S.C. 1395ww note), as amended by sections 
3106(b) and 10312(b) of Public Law 111–148, section 
1206(b)(2) of the Pathway for SGR Reform Act of 
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2013 (division B of Public Law 113–67), and section 
112 of the Protecting Access to Medicare Act of 2014, 
is amended by striking ‘‘The moratorium under para-
graph (1)(A)’’ and inserting ‘‘Any moratorium under 
paragraph (1)’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect as if included in the 
enactment of section 112 of the Protecting Access to 
Medicare Act of 2014. 
(b) MODIFICATION TO MEDICARE LONG-TERM CARE 
HOSPITAL
HIGH
COST
OUTLIER
PAYMENTS.—Section 
1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)) 
is amended by adding at the end the following new para-
graph: 
‘‘(7) TREATMENT OF HIGH COST OUTLIER PAY-
MENTS.— 
‘‘(A) ADJUSTMENT TO THE STANDARD FED-
ERAL
PAYMENT
RATE
FOR
ESTIMATED
HIGH 
COST
OUTLIER
PAYMENTS.—Under the system 
described in paragraph (1), for fiscal years be-
ginning on or after October 1, 2017, the Sec-
retary shall reduce the standard Federal pay-
ment rate as if the estimated aggregate amount 
of high cost outlier payments for standard Fed-
eral payment rate discharges for each such fiscal 
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year would be equal to 8 percent of estimated ag-
gregate payments for standard Federal payment 
rate discharges for each such fiscal year. 
‘‘(B) LIMITATION ON HIGH COST OUTLIER 
PAYMENT AMOUNTS.—Notwithstanding subpara-
graph (A), the Secretary shall set the fixed loss 
amount for high cost outlier payments such that 
the estimated aggregate amount of high cost 
outlier payments made for standard Federal 
payment rate discharges for fiscal years begin-
ning on or after October 1, 2017, shall be equal 
to 99.6875 percent of 8 percent of estimated ag-
gregate payments for standard Federal payment 
rate discharges for each such fiscal year. 
‘‘(C) WAIVER OF BUDGET NEUTRALITY.— 
Any reduction in payments resulting from the 
application of subparagraph (B) shall not be 
taken into account in applying any budget neu-
trality provision under such system. 
‘‘(D) NO EFFECT ON SITE NEUTRAL HIGH 
COST OUTLIER PAYMENT RATE.—This paragraph 
shall not apply with respect to the computation 
of the applicable site neutral payment rate under 
paragraph (6).’’. 
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SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH 
NOT APPLYING DOCUMENTATION AND COD-
ING ADJUSTMENTS. 
Section 7(b)(1)(B)(iii) of the TMA, Abstinence Edu-
cation, and QI Programs Extension Act of 2007 (Public 
Law 110–90), as amended by section 631(b) of the Amer-
ican Taxpayer Relief Act of 2012 (Public Law 122–240) 
and section 414(1)(B)(iii) of the Medicare Access and CHIP 
Reauthorization Act of 2015 (Public Law 114–10), is 
amended by striking ‘‘an increase of 0.5 percentage points 
for discharges occurring during each of fiscal years 2018 
through 2023’’ and inserting ‘‘an increase of 0.4590 per-
centage points for discharges occurring during fiscal year 
2018 and 0.5 percentage points for discharges occurring 
during each of fiscal years 2019 through 2023’’. 
TITLE II—PROVISIONS 
RELATING TO MEDICARE PART B 
SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD 
PROSPECTIVE PAYMENT SYSTEM FOR SERV-
ICES FURNISHED BY MID-BUILD OFF-CAMPUS 
OUTPATIENT DEPARTMENTS OF PROVIDERS. 
(a) IN GENERAL.—Section 1833(t)(21) of the Social 
Security Act (42 U.S.C. 1395l(t)(21)) is amended— 
(1) in subparagraph (B)— 
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(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘the subsequent provisions of this 
subparagraph’’; and 
(B) by adding at the end the following new 
clauses: 
‘‘(iii) 
DEEMED
TREATMENT
FOR 
2017.—For purposes of applying clause (ii) 
with respect to applicable items and services 
furnished during 2017, a department of a 
provider (as so defined) not described in 
such clause is deemed to be billing under 
this subsection with respect to covered OPD 
services furnished prior to November 2, 
2015, if the Secretary received from the pro-
vider prior to December 2, 2015, an attesta-
tion (pursuant to section 413.65(b)(3) of 
title 42 of the Code of Federal Regulations) 
that such department was a department of 
a provider (as so defined). 
‘‘(iv) ALTERNATIVE EXCEPTION BEGIN-
NING
WITH
2018.—For purposes of para-
graph (1)(B)(v) and this paragraph with 
respect to applicable items and services fur-
nished during 2018 or a subsequent year, 
the term ‘off-campus outpatient department 
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of a provider’ also shall not include a de-
partment of a provider (as so defined) that 
is not described in clause (ii) if— 
‘‘(I) the Secretary receives from 
the provider an attestation (pursuant 
to such section 413.65(b)(3)) not later 
than December 31, 2016 (or, if later, 
60 days after the date of the enactment 
of this clause), that such department 
met the requirements of a department 
of a provider specified in section 
413.65 of title 42 of the Code of Fed-
eral Regulations; 
‘‘(II) the provider includes such 
department as part of the provider on 
its enrollment form in accordance with 
the enrollment process under section 
1866(j); and 
‘‘(III) the department met the 
mid-build requirement of clause (v) 
and the Secretary receives, not later 
than 60 days after the date of the en-
actment of this clause, from the chief 
executive officer or chief operating offi-
cer of the provider a written certifi-
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cation that the department met such 
requirement. 
‘‘(v) MID-BUILD
REQUIREMENT
DE-
SCRIBED.—The mid-build requirement of 
this clause is, with respect to a department 
of a provider, that before November 2, 2015, 
the provider had a binding written agree-
ment with an outside unrelated party for 
the actual construction of such department. 
‘‘(vii) AUDIT.—Not later than Decem-
ber 31, 2018, the Secretary shall audit the 
compliance with requirements of clause (iv) 
with respect to each department of a pro-
vider to which such clause applies. If the 
Secretary finds as a result of an audit 
under this clause that the applicable re-
quirements were not met with respect to 
such department, the department shall not 
be excluded from the term ‘off-campus out-
patient department of a provider’ under 
such clause. 
‘‘(viii) IMPLEMENTATION.—For pur-
poses of implementing clauses (iii) through 
(vii): 
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‘‘(I) Notwithstanding any other 
provision of law, the Secretary may 
implement such clauses by program in-
struction or otherwise. 
‘‘(II) Subchapter I of chapter 35 
of title 44, United States Code, shall 
not apply. 
‘‘(III) For purposes of carrying 
out this subparagraph with respect to 
clauses (iii) and (iv) (and clause (vii) 
insofar as it relates to clause (iv)), the 
Secretary shall provide for the transfer 
from the Supplementary Medical In-
surance Trust Fund under section 
1841, of $10,000,000 to the Centers for 
Medicare & Medicaid Services Pro-
gram Management Account to remain 
available until December 31, 2018.’’; 
and 
(2) in subparagraph (E), by adding at the end 
the following new clause: 
‘‘(iv) The determination of an audit 
under subparagraph (B)(vii).’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall be effective as if included in the enactment of 
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section 603 of the Bipartisan Budget Act of 2015 (Public 
Law 114–74). 
SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAM-
PUS OUTPATIENT DEPARTMENT OF A PRO-
VIDER POLICY. 
(a) IN GENERAL.—Section 1833(t)(21)(B) of the So-
cial Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended 
by section 201(a), is amended— 
(1) by inserting after clause (v) the following 
new clause: 
‘‘(vi) EXCLUSION FOR CERTAIN CANCER 
HOSPITALS.—For purposes of paragraph 
(1)(B)(v) and this paragraph with respect 
to applicable items and services furnished 
during 2017 or a subsequent year, the term 
‘off-campus outpatient department of a pro-
vider’ also shall not include a department of 
a provider (as so defined) that is not de-
scribed in clause (ii) if the provider is a 
hospital 
described 
in 
section 
1886(d)(1)(B)(v) and— 
‘‘(I) in the case of a department 
that met the requirements of section 
413.65 of title 42 of the Code of Fed-
eral Regulations after November 1, 
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2015, and before the date of the enact-
ment of this clause, the Secretary re-
ceives from the provider an attestation 
that such department met such require-
ments not later than 60 days after 
such date of enactment; or 
‘‘(II) in the case of a department 
that meets such requirements after such 
date of enactment, the Secretary re-
ceives from the provider an attestation 
that such department meets such re-
quirements not later than 60 days 
after the date such requirements are 
first met with respect to such depart-
ment.’’; 
(2) in clause (vii), by inserting after the first 
sentence the following: ‘‘Not later than 2 years after 
the date the Secretary receives an attestation under 
clause (vi) relating to compliance of a department of 
a provider with requirements referred to in such 
clause, the Secretary shall audit the compliance with 
such requirements with respect to the department.’’; 
and 
(3) in clause (viii)(III), by adding at the end the 
following: ‘‘For purposes of carrying out this sub-
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paragraph with respect to clause (vi) (and clause 
(vii) insofar as it relates to such clause), the Sec-
retary shall provide for the transfer from the Supple-
mentary Medical Insurance Trust Fund under section 
1841, of $2,000,000 to the Centers for Medicare & 
Medicaid Services Program Management Account to 
remain available until expended.’’ 
(b) OFFSETTING SAVINGS.—Section 1833(t)(18) of the 
Social Security Act (42 U.S.C. 1395l(t)(18)) is amended— 
(1) in subparagraph (B), by inserting ‘‘, subject 
to subparagraph (C),’’ after ‘‘shall’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) TARGET PCR ADJUSTMENT.—In apply-
ing section 419.43(i) of title 42 of the Code of 
Federal Regulations to implement the appro-
priate adjustment under this paragraph for serv-
ices furnished on or after January 1, 2018, the 
Secretary shall use a target PCR that is 1.0 per-
centage points less than the target PCR that 
would otherwise apply. In addition to the per-
centage point reduction under the previous sen-
tence, the Secretary may consider making an ad-
ditional percentage point reduction to such tar-
get PCR that takes into account payment rates 
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for applicable items and services described in 
paragraph (21)(C) other than for services fur-
nished 
by 
hospitals 
described 
in 
section 
1886(d)(1)(B)(v). In making any budget neu-
trality adjustments under this subsection for 
2018 or a subsequent year, the Secretary shall 
not take into account the reduced expenditures 
that result from the application of this subpara-
graph.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall be effective as if included in the enactment of 
section 603 of the Bipartisan Budget Act of 2015 (Public 
Law 114–74). 
SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN AM-
BULATORY SURGICAL CENTERS FOR MEAN-
INGFUL USE AND MIPS. 
(a) IN GENERAL.—Section 1848(a)(7)(D) of the Social 
Security Act (42 U.S.C. 1395w–4(a)(7)(D)) is amended— 
(1) by striking ‘‘HOSPITAL-BASED ELIGIBLE PRO-
FESSIONALS’’ and all that follows through ‘‘No pay-
ment’’ and inserting the following: ‘‘HOSPITAL-BASED 
AND
AMBULATORY
SURGICAL
CENTER-BASED
ELIGI-
BLE PROFESSIONALS.— 
‘‘(i) HOSPITAL-BASED.—No payment’’; 
and 
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(2) by adding at the end the following new 
clauses: 
‘‘(ii) AMBULATORY SURGICAL CENTER- 
BASED.—Subject to clause (iv), no payment 
adjustment may be made under subpara-
graph (A) for 2017 and 2018 in the case of 
an eligible professional with respect to 
whom substantially all of the covered profes-
sional services furnished by such profes-
sional are furnished in an ambulatory sur-
gical center. 
‘‘(iii) 
DETERMINATION.—The 
deter-
mination of whether an eligible professional 
is an eligible professional described in 
clause (ii) may be made on the basis of— 
‘‘(I) the site of service (as defined 
by the Secretary); or 
‘‘(II) an attestation submitted by 
the eligible professional. 
Determinations made under subclauses (I) 
and (II) shall be made without regard to 
any employment or billing arrangement be-
tween the eligible professional and any other 
supplier or provider of services. 
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‘‘(iv) SUNSET.—Clause (ii) shall no 
longer apply as of the first year that begins 
more than 3 years after the date on which 
the Secretary determines, through notice 
and comment rulemaking, that certified 
EHR technology applicable to the ambula-
tory surgical center setting is available.’’. 
(b) CONTINUED APPLICATION OF CERTAIN PROVISIONS 
UNDER MIPS.—Section 1848(o)(2)(D) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(o)(2)(D)) is amended by add-
ing at the end the following new sentence: ‘‘The provisions 
of subparagraphs (B) and (D) of subsection (a)(7), includ-
ing the application of clause (iv) of such subparagraph (D), 
shall apply to assessments of MIPS eligible professionals 
under subsection (q) with respect to the performance cat-
egory described in subsection (q)(2)(A)(iv) in a manner 
similar to the manner in which such provisions apply with 
respect to payment adjustments made under subsection 
(a)(7)(A).’’. 
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TITLE III—OTHER MEDICARE 
PROVISIONS 
SEC. 301. DELAY IN AUTHORITY TO TERMINATE CONTRACTS 
FOR MEDICARE ADVANTAGE PLANS FAILING 
TO ACHIEVE MINIMUM QUALITY RATINGS. 
(a) FINDINGS.—Consistent with the studies provided 
under the IMPACT Act of 2014 (Public Law 113–185), it 
is the intent of Congress— 
(1) to continue to study and request input on the 
effects of socioeconomic status and dual-eligible popu-
lations on the Medicare Advantage STARS rating 
system before reforming such system with the input of 
stakeholders; and 
(2) pending the results of such studies and input, 
to provide for a temporary delay in authority of the 
Centers for Medicare & Medicaid Services (CMS) to 
terminate Medicare Advantage plan contracts solely 
on the basis of performance of plans under the 
STARS rating system. 
(b) DELAY IN MA CONTRACT TERMINATION AUTHOR-
ITY FOR PLANS FAILING TO ACHIEVE MINIMUM QUALITY 
RATINGS.—Section 1857(h) of the Social Security Act (42 
U.S.C. 1395w–27(h)) is amended by adding at the end the 
following new paragraph: 
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