H. R. 4994—3 
‘‘(i) QUALITY
MEASURES.—In the case of quality 
measures under subsection (c)(1)— 
‘‘(I) with respect to the domain described in 
subsection (c)(1)(A) (relating to functional status, 
cognitive function, and changes in function and 
cognitive function)— 
‘‘(aa) for PAC providers described in 
clauses (ii) and (iii) of paragraph (2)(A), 
October 1, 2016; 
‘‘(bb) for PAC providers described in clause 
(iv) of such paragraph, October 1, 2018; and 
‘‘(cc) for PAC providers described in clause 
(i) of such paragraph, January 1, 2019; 
‘‘(II) with respect to the domain described in 
subsection (c)(1)(B) (relating to skin integrity and 
changes in skin integrity)— 
‘‘(aa) for PAC providers described in 
clauses (ii), (iii), and (iv) of paragraph (2)(A), 
October 1, 2016; and 
‘‘(bb) for PAC providers described in clause 
(i) of such paragraph, January 1, 2017; 
‘‘(III) with respect to the domain described 
in subsection (c)(1)(C) (relating to medication rec-
onciliation)— 
‘‘(aa) for PAC providers described in clause 
(i) of such paragraph, January 1, 2017; and 
‘‘(bb) for PAC providers described in 
clauses (ii), (iii), and (iv) of such paragraph, 
October 1, 2018; 
‘‘(IV) with respect to the domain described in 
subsection (c)(1)(D) (relating to incidence of major 
falls)— 
‘‘(aa) for PAC providers described in 
clauses (ii), (iii), and (iv) of paragraph (2)(A), 
October 1, 2016; and 
‘‘(bb) for PAC providers described in clause 
(i) of such paragraph, January 1, 2019; and 
‘‘(V) with respect to the domain described in 
subsection (c)(1)(E) (relating to accurately commu-
nicating the existence of and providing for the 
transfer of health information and care pref-
erences)— 
‘‘(aa) for PAC providers described in 
clauses (ii), (iii), and (iv) of paragraph (2)(A), 
October 1, 2018; and 
‘‘(bb) for PAC providers described in clause 
(i) of such paragraph, January 1, 2019. 
‘‘(ii) RESOURCE USE AND OTHER MEASURES.—In the 
case of resource use and other measures under sub-
section (d)(1)— 
‘‘(I) for PAC providers described in clauses 
(ii), (iii), and (iv) of paragraph (2)(A), October 1, 
2016; and 
‘‘(II) for PAC providers described in clause (i) 
of such paragraph, January 1, 2017. 
‘‘(F) MEDICARE
BENEFICIARY.—The term ‘Medicare 
beneficiary’ means an individual entitled to benefits under
H. R. 4994—4 
part A or, as appropriate, enrolled for benefits under part 
B. 
‘‘(b) STANDARDIZED PATIENT ASSESSMENT DATA.— 
‘‘(1) REQUIREMENT FOR REPORTING ASSESSMENT DATA.— 
‘‘(A) IN GENERAL.—Beginning not later than October 
1, 2018, for PAC providers described in clauses (ii), (iii), 
and (iv) of subsection (a)(2)(A) and January 1, 2019, for 
PAC providers described in clause (i) of such subsection, 
the Secretary shall require PAC providers to submit to 
the Secretary, under the applicable reporting provisions 
and through the use of PAC assessment instruments, the 
standardized patient assessment data described in subpara-
graph (B). The Secretary shall require such data be sub-
mitted with respect to admission and discharge of an indi-
vidual (and may be submitted more frequently as the Sec-
retary deems appropriate). 
‘‘(B) 
STANDARDIZED
PATIENT
ASSESSMENT
DATA 
DESCRIBED.—For purposes of subparagraph (A), the 
standardized patient assessment data described in this 
subparagraph is data required for at least the quality meas-
ures described in subsection (c)(1) and that is with respect 
to the following categories: 
‘‘(i) Functional status, such as mobility and self 
care at admission to a PAC provider and before dis-
charge from a PAC provider. 
‘‘(ii) Cognitive function, such as ability to express 
ideas and to understand, and mental status, such as 
depression and dementia. 
‘‘(iii) Special services, treatments, and interven-
tions, such as need for ventilator use, dialysis, chemo-
therapy, central line placement, and total parenteral 
nutrition. 
‘‘(iv) Medical conditions and co-morbidities, such 
as diabetes, congestive heart failure, and pressure 
ulcers. 
‘‘(v) Impairments, such as incontinence and an 
impaired ability to hear, see, or swallow. 
‘‘(vi) Other categories deemed necessary and appro-
priate by the Secretary. 
‘‘(2) ALIGNMENT
OF
CLAIMS
DATA
WITH
STANDARDIZED 
PATIENT ASSESSMENT DATA.—To the extent practicable, not later 
than October 1, 2018, for PAC providers described in clauses 
(ii), (iii), and (iv) of subsection (a)(2)(A), and January 1, 2019, 
for PAC providers described in clause (i) of such subsection, 
the Secretary shall match claims data with assessment data 
pursuant to this section for purposes of assessing prior service 
use and concurrent service use, such as antecedent hospital 
or PAC provider use, and may use such matched data for 
such other uses as the Secretary determines appropriate. 
‘‘(3) REPLACEMENT OF CERTAIN EXISTING DATA.—In the case 
of patient assessment data being used with respect to a PAC 
assessment instrument that duplicates or overlaps with 
standardized patient assessment data within a category 
described in paragraph (1), the Secretary shall, as soon as 
practicable, revise or replace such existing data with the 
standardized data.
H. R. 4994—5 
‘‘(4) CLARIFICATION.—Standardized patient assessment data 
submitted pursuant to this subsection shall not be used to 
require individuals to be provided post-acute care by a specific 
type of PAC provider in order for such care to be eligible 
for payment under this title. 
‘‘(c) QUALITY MEASURES.— 
‘‘(1) REQUIREMENT FOR REPORTING QUALITY MEASURES.— 
Not later than the specified application date, as applicable 
to measures and PAC providers, the Secretary shall specify 
quality measures on which PAC providers are required under 
the applicable reporting provisions to submit standardized 
patient assessment data described in subsection (b)(1) and other 
necessary data specified by the Secretary. Such measures shall 
be with respect to at least the following domains: 
‘‘(A) Functional status, cognitive function, and changes 
in function and cognitive function. 
‘‘(B) Skin integrity and changes in skin integrity. 
‘‘(C) Medication reconciliation. 
‘‘(D) Incidence of major falls. 
‘‘(E) Accurately communicating the existence of and 
providing for the transfer of health information and care 
preferences of an individual to the individual, family care-
giver of the individual, and providers of services furnishing 
items and services to the individual, when the individual 
transitions— 
‘‘(i) from a hospital or critical access hospital to 
another applicable setting, including a PAC provider 
or the home of the individual; or 
‘‘(ii) from a PAC provider to another applicable 
setting, including a different PAC provider, a hospital, 
a critical access hospital, or the home of the individual. 
‘‘(2) REPORTING THROUGH PAC ASSESSMENT INSTRUMENTS.— 
‘‘(A) IN GENERAL.—To the extent possible, the Secretary 
shall require such reporting by a PAC provider of quality 
measures under paragraph (1) through the use of a PAC 
assessment instrument and shall modify such PAC assess-
ment instrument as necessary to enable the use of such 
instrument with respect to such quality measures. 
‘‘(B) LIMITATION.—The Secretary may not make signifi-
cant modifications to a PAC assessment instrument more 
than once per calendar year or fiscal year, as applicable, 
unless the Secretary publishes in the Federal Register a 
justification for such significant modification. 
‘‘(3) ADJUSTMENTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall consider 
applying adjustments to the quality measures under this 
subsection taking into consideration the studies under sec-
tion 2(d) of the IMPACT Act of 2014. 
‘‘(B) RISK ADJUSTMENT.—Such quality measures shall 
be risk adjusted, as determined appropriate by the Sec-
retary. 
‘‘(d) RESOURCE USE AND OTHER MEASURES.— 
‘‘(1) REQUIREMENT FOR RESOURCE USE AND OTHER MEAS-
URES.—Not later than the specified application date, as 
applicable to measures and PAC providers, the Secretary shall 
specify resource use and other measures on which PAC pro-
viders are required under the applicable reporting provisions
H. R. 4994—6 
to submit any necessary data specified by the Secretary, which 
may include standardized assessment data in addition to claims 
data. Such measures shall be with respect to at least the 
following domains: 
‘‘(A) Resource use measures, including total estimated 
Medicare spending per beneficiary. 
‘‘(B) Discharge to community. 
‘‘(C) Measures to reflect all-condition risk-adjusted 
potentially preventable hospital readmission rates. 
‘‘(2) ALIGNING METHODOLOGY ADJUSTMENTS FOR RESOURCE 
USE MEASURES.— 
‘‘(A) PERIOD OF TIME.—With respect to the period of 
time used for calculating measures under paragraph (1)(A), 
the Secretary shall, to the extent the Secretary determines 
appropriate, align resource use with the methodology used 
for purposes of section 1886(o)(2)(B)(ii). 
‘‘(B) GEOGRAPHIC AND OTHER ADJUSTMENTS.—The Sec-
retary shall standardize measures with respect to the 
domain described in paragraph (1)(A) for geographic pay-
ment rate differences and payment differentials (and other 
adjustments, as applicable) consistent with the method-
ology published in the Federal Register on August 18, 
2011 (76 Fed. Reg. 51624 through 51626), or any subse-
quent modifications made to the methodology. 
‘‘(C) MEDICARE SPENDING PER BENEFICIARY.—The Sec-
retary shall adjust, as appropriate, measures with respect 
to the domain described in paragraph (1)(A) for the factors 
applied under section 1886(o)(2)(B)(ii). 
‘‘(3) ADJUSTMENTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall consider 
applying adjustments to the resource use and other meas-
ures specified under this subsection with respect to the 
domain described in paragraph (1)(A), taking into consider-
ation the studies under section 2(d) of the IMPACT Act 
of 2014. 
‘‘(B) RISK ADJUSTMENT.—Such resource use and other 
measures shall be risk adjusted, as determined appropriate 
by the Secretary. 
‘‘(e) MEASUREMENT IMPLEMENTATION PHASES; SELECTION
OF 
QUALITY MEASURES AND RESOURCE USE AND OTHER MEASURES.— 
‘‘(1) MEASUREMENT IMPLEMENTATION PHASES.—In the case 
of quality measures specified under subsection (c)(1) and 
resource use and other measures specified under subsection 
(d)(1), the provisions of this section shall be implemented in 
accordance with the following phases: 
‘‘(A) INITIAL
IMPLEMENTATION
PHASE.—The initial 
implementation phase, with respect to such a measure, 
shall, in accordance with subsections (c) and (d), as 
applicable, consist of— 
‘‘(i) measure specification, including informing the 
public of the measure’s numerator, denominator, exclu-
sions, and any other aspects the Secretary determines 
necessary; 
‘‘(ii) data collection, including, in the case of quality 
measures, requiring PAC providers to report data ele-
ments needed to calculate such a measure; and
H. R. 4994—7 
‘‘(iii) data analysis, including, in the case of 
resource use and other measures, the use of claims 
data to calculate such a measure. 
‘‘(B) SECOND
IMPLEMENTATION
PHASE.—The second 
implementation phase, with respect to such a measure, 
shall consist of the provision of feedback reports to PAC 
providers, in accordance with subsection (f). 
‘‘(C) 
THIRD
IMPLEMENTATION
PHASE.—The 
third 
implementation phase, with respect to such a measure, 
shall consist of public reporting of PAC providers’ perform-
ance on such measure in accordance with subsection (g). 
‘‘(2) CONSENSUS-BASED ENTITY.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), each 
measure specified by the Secretary under this section shall 
be endorsed by the entity with a contract under section 
1890(a). 
‘‘(B) EXCEPTION.—In the case of a specified area or 
medical topic determined appropriate by the Secretary for 
which a feasible and practical measure has not been 
endorsed by the entity with a contract under section 
1890(a), the Secretary may specify a measure that is not 
so endorsed as long as due consideration is given to meas-
ures that have been endorsed or adopted by a consensus 
organization identified by the Secretary. 
‘‘(3) TREATMENT
OF
APPLICATION
OF
PRE-RULEMAKING 
PROCESS (MEASURE APPLICATIONS PARTNERSHIP PROCESS).— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
provisions of section 1890A shall apply in the case of a 
quality measure specified under subsection (c) or a resource 
use or other measure specified under subsection (d). 
‘‘(B) EXCEPTIONS.— 
‘‘(i) EXPEDITED
PROCEDURES.—For purposes of 
satisfying subparagraph (A), the Secretary may use 
expedited procedures, such as ad-hoc reviews, as nec-
essary, in the case of a quality measure specified under 
subsection (c) or a resource use or other measure speci-
fied in subsection (d) required with respect to data 
submissions under the applicable reporting provisions 
during the 1-year period before the specified applica-
tion date applicable to such a measure and provider 
involved. 
‘‘(ii) OPTION TO WAIVE PROVISIONS.—The Secretary 
may waive the application of the provisions of section 
1890A in the case of a quality measure or resource 
use or other measure described in clause (i), if the 
application of such provisions (including through the 
use of an expedited procedure described in such clause) 
would result in the inability of the Secretary to satisfy 
any deadline specified in this section with respect to 
such measure. 
‘‘(f) FEEDBACK REPORTS TO PAC PROVIDERS.— 
‘‘(1) IN GENERAL.—Beginning one year after the specified 
application date, as applicable to PAC providers and quality 
measures and resource use and other measures under this 
section, the Secretary shall provide confidential feedback 
reports to such PAC providers on the performance of such
H. R. 4994—8 
providers with respect to such measures required under the 
applicable provisions. 
‘‘(2) FREQUENCY.—To the extent feasible, the Secretary 
shall provide feedback reports described in paragraph (1) not 
less frequently than on a quarterly basis. Notwithstanding 
the previous sentence, with respect to measures described in 
such paragraph that are reported on an annual basis, the 
Secretary may provide such feedback reports on an annual 
basis. 
‘‘(g) PUBLIC REPORTING
OF PAC PROVIDER PERFORMANCE.— 
‘‘(1) IN GENERAL.—Subject to the succeeding paragraphs 
of this subsection, the Secretary shall provide for public 
reporting of PAC provider performance on quality measures 
under subsection (c)(1) and the resource use and other measures 
under subsection (d)(1), including by establishing procedures 
for making available to the public information regarding the 
performance of individual PAC providers with respect to such 
measures. 
‘‘(2) OPPORTUNITY TO REVIEW.—The procedures under para-
graph (1) shall ensure, including through a process consistent 
with the process applied under section 1886(b)(3)(B)(viii)(VII) 
for similar purposes, that a PAC provider has the opportunity 
to review and submit corrections to the data and information 
that is to be made public with respect to the provider prior 
to such data being made public. 
‘‘(3) TIMING.—Such procedures shall provide that the data 
and information described in paragraph (1), with respect to 
a measure and PAC provider, is made publicly available begin-
ning not later than two years after the specified application 
date applicable to such a measure and provider. 
‘‘(4) COORDINATION WITH EXISTING PROGRAMS.—Such proce-
dures shall provide that data and information described in 
paragraph (1) with respect to quality measures and resource 
use and other measures under subsections (c)(1) and (d)(1) 
shall be made publicly available consistent with the following 
provisions: 
‘‘(A) In the case of home health agencies, section 
1895(b)(3)(B)(v)(III). 
‘‘(B) In the case of skilled nursing facilities, sections 
1819(i) and 1919(i). 
‘‘(C) In the case of inpatient rehabilitation facilities, 
section 1886(j)(7)(E). 
‘‘(D) In the case of long-term care hospitals, section 
1886(m)(5)(E). 
‘‘(h) REMOVING, SUSPENDING, OR ADDING MEASURES.— 
‘‘(1) IN
GENERAL.—The Secretary may remove, suspend, 
or add a quality measure or resource use or other measure 
described in subsection (c)(1) or (d)(1), so long as, subject to 
paragraph (2), the Secretary publishes in the Federal Register 
(with a notice and comment period) a justification for such 
removal, suspension, or addition. 
‘‘(2) EXCEPTION.—In the case of such a quality measure 
or resource use or other measure for which there is a reason 
to believe that the continued collection of such measure raises 
potential safety concerns or would cause other unintended con-
sequences, the Secretary may promptly suspend or remove 
such measure and satisfy paragraph (1) by publishing in the
H. R. 4994—9 
Federal Register a justification for such suspension or removal 
in the next rulemaking cycle following such suspension or 
removal. 
‘‘(i) USE OF STANDARDIZED ASSESSMENT DATA, QUALITY MEAS-
URES, AND RESOURCE USE AND OTHER MEASURES TO INFORM DIS-
CHARGE PLANNING AND INCORPORATE PATIENT PREFERENCE.— 
‘‘(1) IN GENERAL.—Not later than January 1, 2016, and 
periodically thereafter (but not less frequently than once every 
5 years), the Secretary shall promulgate regulations to modify 
conditions of participation and subsequent interpretive guid-
ance applicable to PAC providers, hospitals, and critical access 
hospitals. Such regulations and interpretive guidance shall 
require such providers to take into account quality, resource 
use, and other measures under the applicable reporting provi-
sions (which, as available, shall include measures specified 
under subsections (c) and (d), and other relevant measures) 
in the discharge planning process. Specifically, such regulations 
and interpretive guidance shall address the settings to which 
a patient may be discharged in order to assist subsection (d) 
hospitals, critical access hospitals, hospitals described in section 
1886(d)(1)(B)(v), PAC providers, patients, and families of such 
patients with discharge planning from inpatient settings, 
including such hospitals, and from PAC provider settings. In 
addition, such regulations and interpretive guidance shall 
include procedures to address— 
‘‘(A) treatment preferences of patients; and 
‘‘(B) goals of care of patients. 
‘‘(2) DISCHARGE
PLANNING.—All requirements applied 
pursuant to paragraph (1) shall be used to help inform and 
mandate the discharge planning process. 
‘‘(3) CLARIFICATION.—Such regulations shall not require an 
individual to be provided post-acute care by a specific type 
of PAC provider in order for such care to be eligible for payment 
under this title. 
‘‘(j) STAKEHOLDER INPUT.—Before the initial rulemaking process 
to implement this section, the Secretary shall allow for stakeholder 
input, such as through town halls, open door forums, and mail- 
box submissions. 
‘‘(k) FUNDING.—For purposes of carrying out this section, the 
Secretary shall provide for the transfer to the Centers for Medicare 
& Medicaid Services Program Management Account, from the Fed-
eral Hospital Insurance Trust Fund under section 1817 and the 
Federal Supplementary Medical Insurance Trust Fund under sec-
tion 1841, in such proportion as the Secretary determines appro-
priate, of $130,000,000. Fifty percent of such amount shall be avail-
able on the date of the enactment of this section and fifty percent 
of such amount shall be equally proportioned for each of fiscal 
years 2015 through 2019. Such sums shall remain available until 
expended. 
‘‘(l) LIMITATION.—There shall be no administrative or judicial 
review under sections 1869 and 1878 or otherwise of the specifica-
tion of standardized patient assessment data required, the deter-
mination of measures, and the systems to report such standardized 
data under this section. 
‘‘(m) NON-APPLICATION
OF
PAPERWORK
REDUCTION
ACT.— 
Chapter 35 of title 44, United States Code (commonly referred 
to as the ‘Paperwork Reduction Act of 1995’) shall not apply to
H. R. 4994—10 
this section and the sections referenced in subsection (a)(2)(B) that 
require modification in order to achieve the standardization of 
patient assessment data.’’. 
(b) STUDIES OF ALTERNATIVE PAC PAYMENT MODELS.— 
(1) MEDPAC.—Using data from the Post-Acute Payment 
Reform Demonstration authorized under section 5008 of the 
Deficit Reduction Act of 2005 (Public Law 109–171) or other 
data, as available, not later than June 30, 2016, the Medicare 
Payment Advisory Commission shall submit to Congress a 
report that evaluates and recommends features of PAC payment 
systems (as defined in section 1899B(a)(2)(D) of the Social 
Security Act, as added by subsection (a)) that establish, or 
a unified post-acute care payment system under title XVIII 
of the Social Security Act that establishes, payment rates 
according to characteristics of individuals (such as cognitive 
ability, functional status, and impairments) instead of according 
to the post-acute care setting where the Medicare beneficiary 
involved is treated. To the extent feasible, such report shall 
consider the impacts of moving from PAC payment systems 
(as defined in subsection (a)(2)(D) of such section 1899B) in 
existence as of the date of the enactment of this Act to new 
post-acute care payment systems under title XVIII of the Social 
Security Act. 
(2) RECOMMENDATIONS FOR PAC PROSPECTIVE PAYMENT.— 
(A) REPORT BY SECRETARY.—Not later than 2 years 
after the date by which the Secretary of Health and Human 
Services has collected 2 years of data on quality measures 
under subsection (c) of section 1899B, as added by sub-
section (a), the Secretary shall, in consultation with the 
Medicare Payment Advisory Commission and appropriate 
stakeholders, submit to Congress a report, including— 
(i) recommendations and a technical prototype, on 
a post-acute care prospective payment system under 
title XVIII of the Social Security Act that would— 
(I) in lieu of the rates that would otherwise 
apply under PAC payment systems (as defined 
in subsection (a)(2)(D) of such section 1899B), base 
payments under such title, with respect to items 
and services furnished to an individual by a PAC 
provider (as defined in subsection (a)(2)(A) of such 
section), according to individual characteristics 
(such as cognitive ability, functional status, and 
impairments) of such individual instead of the 
post-acute care setting in which the individual is 
furnished such items and services; 
(II) account for the clinical appropriateness 
of items and services so furnished and Medicare 
beneficiary outcomes; 
(III) be designed to incorporate (or otherwise 
account for) standardized patient assessment data 
under section 1899B; and 
(IV) further clinical integration, such as by 
motivating greater coordination around a single 
condition or procedure to integrate hospital sys-
tems with PAC providers (as so defined).
H. R. 4994—11 
(ii) recommendations on which Medicare fee-for- 
service regulations for post-acute care payment sys-
tems under title XVIII of the Social Security Act should 
be altered (such as the skilled nursing facility 3-day 
stay and inpatient rehabilitation facility 60 percent 
rule); 
(iii) an analysis of the impact of the recommended 
payment system described in clause (i) on Medicare 
beneficiary cost-sharing, access to care, and choice of 
setting; 
(iv) a projection of any potential reduction in 
expenditures under title XVIII of the Social Security 
Act that may be attributable to the application of the 
recommended payment system described in clause (i); 
and 
(v) a review of the value of subsection (d) hospitals 
(as defined in section 1886(d)(1)(B) of the Social Secu-
rity 
Act 
(42 
U.S.C. 
1395ww(d)(1)(B)), 
hospitals 
described in section 1886(d)(1)(B)(v) of such Act (42 
U.S.C. 1395ww(d)(1)(B)(v)), and critical access hos-
pitals described in section 1820(c)(2)(B) of such Act 
(42 U.S.C. 1395i–4(c)(2)(B)) collecting and reporting 
to the Secretary standardized patient assessment data 
with respect to inpatient hospital services furnished 
by such a hospital or critical access hospital to individ-
uals who are entitled to benefits under part A of title 
XVIII of such Act or, as appropriate, enrolled for bene-
fits under part B of such title. 
(B) REPORT BY MEDPAC.—Not later than the first June 
30th following the date on which the report is required 
under subparagraph (A), the Medicare Payment Advisory 
Commission shall submit to Congress a report, including 
recommendations and a technical prototype, on a post- 
acute care prospective payment system under title XVIII 
of the Social Security Act that would satisfy the criteria 
described in subparagraph (A). 
(3) MEDICARE BENEFICIARY DEFINED.—For purposes of this 
subsection, the term ‘‘Medicare beneficiary’’ has the meaning 
given such term in section 1899B(a)(2) of the Social Security 
Act, as added by subsection (a). 
(c) 
PAYMENT
CONSEQUENCES
UNDER
THE
APPLICABLE 
REPORTING PROVISIONS.— 
(1) HOME HEALTH AGENCIES.—Section 1895(b)(3)(B)(v) of 
the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)(v)) is 
amended— 
(A) in subclause (I), by striking ‘‘subclause (II)’’ and 
inserting ‘‘subclauses (II) and (IV)’’; 
(B) in subclause (II), by striking ‘‘For 2007’’ and 
inserting ‘‘Subject to subclause (V), for 2007’’; 
(C) in subclause (III), by inserting ‘‘and subclause 
(IV)(aa)’’ after ‘‘subclause (II)’’; and 
(D) by adding at the end the following new subclauses: 
‘‘(IV) SUBMISSION OF ADDITIONAL DATA.— 
‘‘(aa) IN GENERAL.—For the year beginning 
on the specified application date (as defined 
in subsection (a)(2)(E) of section 1899B), as
H. R. 4994—12 
applicable with respect to home health agen-
cies and quality measures under subsection 
(c)(1) of such section and measures under sub-
section (d)(1) of such section, and each subse-
quent year, in addition to the data described 
in subclause (II), each home health agency 
shall submit to the Secretary data on such 
quality measures and any necessary data 
specified by the Secretary under such sub-
section (d)(1). 
‘‘(bb) STANDARDIZED PATIENT ASSESSMENT 
DATA.—For 2019 and each subsequent year, 
in addition to such data described in item 
(aa), each home health agency shall submit 
to the Secretary standardized patient assess-
ment data required under subsection (b)(1) of 
section 1899B. 
‘‘(cc) SUBMISSION.—Data shall be sub-
mitted under items (aa) and (bb) in the form 
and manner, and at the time, specified by 
the Secretary for purposes of this clause. 
‘‘(V) NON-DUPLICATION.—To the extent data 
submitted under subclause (IV) duplicates other 
data required to be submitted under subclause 
(II), the submission of such data under subclause 
(IV) shall be in lieu of the submission of such 
data under subclause (II). The previous sentence 
shall not apply insofar as the Secretary determines 
it is necessary to avoid a delay in the implementa-
tion of section 1899B, taking into account the dif-
ferent specified application dates under subsection 
(a)(2)(E) of such section.’’. 
(2) 
INPATIENT
REHABILITATION
FACILITIES.—Section 
1886(j)(7) of the Social Security Act (42 U.S.C. 1395ww(j)(7)) 
is amended— 
(A) in subparagraph (A)(i), by striking ‘‘subparagraph 
(C)’’ and inserting ‘‘subparagraphs (C) and (F)’’; 
(B) in subparagraph (C), by striking ‘‘For fiscal year 
2014 and each subsequent rate year’’ and inserting ‘‘Subject 
to subparagraph (G), for fiscal year 2014 and each subse-
quent fiscal year’’; 
(C) in subparagraph (E), by inserting ‘‘and subpara-
graph (F)(i)’’ after ‘‘subparagraph (C)’’; and 
(D) by adding at the end the following new subpara-
graphs: 
‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 
‘‘(i) IN
GENERAL.—For the fiscal year beginning 
on the specified application date (as defined in sub-
section (a)(2)(E) of section 1899B), as applicable with 
respect to inpatient rehabilitation facilities and quality 
measures under subsection (c)(1) of such section and 
measures under subsection (d)(1) of such section, and 
each subsequent fiscal year, in addition to such data 
on the quality measures described in subparagraph 
(C), each rehabilitation facility shall submit to the 
Secretary data on the quality measures under such
H. R. 4994—13 
subsection (c)(1) and any necessary data specified by 
the Secretary under such subsection (d)(1). 
‘‘(ii) STANDARDIZED PATIENT ASSESSMENT DATA.— 
For fiscal year 2019 and each subsequent fiscal year, 
in addition to such data described in clause (i), each 
rehabilitation facility shall submit to the Secretary 
standardized patient assessment data required under 
subsection (b)(1) of section 1899B. 
‘‘(iii) SUBMISSION.—Such data shall be submitted 
in the form and manner, and at the time, specified 
by the Secretary for purposes of this subparagraph. 
‘‘(G) NON-DUPLICATION.—To the extent data submitted 
under subparagraph (F) duplicates other data required to 
be submitted under subparagraph (C), the submission of 
such data under subparagraph (F) shall be in lieu of the 
submission of such data under subparagraph (C). The pre-
vious sentence shall not apply insofar as the Secretary 
determines it is necessary to avoid a delay in the 
implementation of section 1899B, taking into account the 
different specified application dates under subsection 
(a)(2)(E) of such section.’’. 
(3) LONG-TERM CARE HOSPITALS.—Section 1886(m)(5) of the 
Social Security Act (42 U.S.C. 1395ww(m)(5)) is amended— 
(A) in subparagraph (A)(i), by striking ‘‘subparagraph 
(C)’’ and inserting ‘‘subparagraphs (C) and (F)’’; 
(B) in subparagraph (C), by striking ‘‘For rate year’’ 
and inserting ‘‘Subject to subparagraph (G), for rate year’’; 
(C) in subparagraph (E), by inserting ‘‘and subpara-
graph (F)(i)’’ after ‘‘subparagraph (C)’’; and 
(D) by adding at the end the following new subpara-
graphs: 
‘‘(F) SUBMISSION OF ADDITIONAL DATA.— 
‘‘(i) IN GENERAL.—For the rate year beginning on 
the specified application date (as defined in subsection 
(a)(2)(E) of section 1899B), as applicable with respect 
to long-term care hospitals and quality measures under 
subsection (c)(1) of such section and measures under 
subsection (d)(1) of such section, and each subsequent 
rate year, in addition to the data on the quality meas-
ures described in subparagraph (C), each long-term 
care hospital (other than a hospital classified under 
subsection (d)(1)(B)(iv)(II)) shall submit to the Sec-
retary data on the quality measures under such sub-
section (c)(1) and any necessary data specified by the 
Secretary under such subsection (d)(1). 
‘‘(ii) STANDARDIZED PATIENT ASSESSMENT DATA.— 
For rate year 2019 and each subsequent rate year, 
in addition to such data described in clause (i), each 
long-term care hospital (other than a hospital classified 
under subsection (d)(1)(B)(iv)(II)) shall submit to the 
Secretary 
standardized 
patient 
assessment 
data 
required under subsection (b)(1) of section 1899B. 
‘‘(iii) SUBMISSION.—Such data shall be submitted 
in the form and manner, and at the time, specified 
by the Secretary for purposes of this subparagraph. 
‘‘(G) NON-DUPLICATION.—To the extent data submitted 
under subparagraph (F) duplicates other data required to
H. R. 4994—14 
be submitted under subparagraph (C), the submission of 
such data under subparagraph (F) shall be in lieu of the 
submission of such data under subparagraph (C). The pre-
vious sentence shall not apply insofar as the Secretary 
determines it is necessary to avoid a delay in the 
implementation of section 1899B, taking into account the 
different specified application dates under subsection 
(a)(2)(E) of such section.’’. 
(4) SKILLED NURSING FACILITIES.— 
(A) IN GENERAL.—Paragraph (6) of section 1888(e) of 
the Social Security Act (42 U.S.C. 1395yy(e)) is amended 
to read as follows: 
‘‘(6) REPORTING OF ASSESSMENT AND QUALITY DATA.— 
‘‘(A) REDUCTION IN UPDATE FOR FAILURE TO REPORT.— 
‘‘(i) IN GENERAL.—For fiscal years beginning with 
fiscal year 2018, in the case of a skilled nursing facility 
that does not submit data, as applicable, in accordance 
with subclauses (II) and (III) of subparagraph (B)(i) 
with respect to such a fiscal year, after determining 
the percentage described in paragraph (5)(B)(i), and 
after application of paragraph (5)(B)(ii), the Secretary 
shall reduce such percentage for payment rates during 
such fiscal year by 2 percentage points. 
‘‘(ii) SPECIAL
RULE.—The application of this 
subparagraph may result in the percentage described 
in paragraph (5)(B)(i), after application of paragraph 
(5)(B)(ii), being less than 0.0 for a fiscal year, and 
may result in payment rates under this subsection 
for a fiscal year being less than such payment rates 
for the preceding fiscal year. 
‘‘(iii) NONCUMULATIVE
APPLICATION.—Any reduc-
tion under clause (i) shall apply only with respect 
to the fiscal year involved and the Secretary shall 
not take into account such reduction in computing 
the payment amount under this subsection for a subse-
quent fiscal year. 
‘‘(B) ASSESSMENT AND MEASURE DATA.— 
‘‘(i) IN GENERAL.—A skilled nursing facility, or a 
facility (other than a critical access hospital) described 
in paragraph (7)(B), shall submit to the Secretary, 
in a manner and within the timeframes prescribed 
by the Secretary— 
‘‘(I) subject to clause (iii), the resident assess-
ment data necessary to develop and implement 
the rates under this subsection; 
‘‘(II) for fiscal years beginning on or after the 
specified application date (as defined in subsection 
(a)(2)(E) of section 1899B), as applicable with 
respect to skilled nursing facilities and quality 
measures under subsection (c)(1) of such section 
and measures under subsection (d)(1) of such sec-
tion, data on such quality measures under such 
subsection (c)(1) and any necessary data specified 
by the Secretary under such subsection (d)(1); and 
‘‘(III) for fiscal years beginning on or after 
October 1, 2018, standardized patient assessment
H. R. 4994—15 
data required under subsection (b)(1) of section 
1899B. 
‘‘(ii) USE OF STANDARD INSTRUMENT.—For purposes 
of meeting the requirement under clause (i), a skilled 
nursing facility, or a facility (other than a critical 
access hospital) described in paragraph (7)(B), may 
submit the resident assessment data required under 
section 1819(b)(3), using the standard instrument des-
ignated by the State under section 1819(e)(5). 
‘‘(iii) NON-DUPLICATION.—To the extent data sub-
mitted under subclause (II) or (III) of clause (i) dupli-
cates other data required to be submitted under clause 
(i)(I), the submission of such data under such a sub-
clause shall be in lieu of the submission of such data 
under clause (i)(I). The previous sentence shall not 
apply insofar as the Secretary determines it is nec-
essary to avoid a delay in the implementation of section 
1899B, taking into account the different specified 
application dates under subsection (a)(2)(E) of such 
section.’’. 
(B) FUNDING FOR NURSING HOME COMPARE WEBSITE.— 
Section 1819(i) of the Social Security Act (42 U.S.C. 1395i– 
3(i)) is amended by adding at the end the following new 
paragraph: 
‘‘(3) FUNDING.—The Secretary shall transfer to the Centers 
for Medicare & Medicaid Services Program Management 
Account, from the Federal Hospital Insurance Trust Fund under 
section 1817 a one-time allocation of $11,000,000. The amount 
shall be available on the date of the enactment of this para-
graph. Such sums shall remain available until expended. Such 
sums shall be used to implement section 1128I(g).’’. 
(d) IMPROVING PAYMENT ACCURACY UNDER THE PAC PAYMENT 
SYSTEMS AND OTHER MEDICARE PAYMENT SYSTEMS.— 
(1) STUDIES AND REPORTS OF EFFECT OF CERTAIN INFORMA-
TION ON QUALITY AND RESOURCE USE.— 
(A) STUDY USING EXISTING MEDICARE DATA.— 
(i) STUDY.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Sec-
retary’’) shall conduct a study that examines the effect 
of individuals’ socioeconomic status on quality meas-
ures and resource use and other measures for individ-
uals under the Medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) 
(such as to recognize that less healthy individuals may 
require more intensive interventions). The study shall 
use information collected on such individuals in car-
rying out such program, such as urban and rural loca-
tion, eligibility for Medicaid under title XIX of such 
Act (42 U.S.C. 1396 et seq.) (recognizing and 
accounting for varying Medicaid eligibility across 
States), and eligibility for benefits under the supple-
mental security income (SSI) program. The Secretary 
shall carry out this paragraph acting through the 
Assistant Secretary for Planning and Evaluation. 
(ii) REPORT.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary shall submit
H. R. 4994—16 
to Congress a report on the study conducted under 
clause (i). 
(B) STUDY USING OTHER DATA.— 
(i) STUDY.—The Secretary shall conduct a study 
that examines the impact of risk factors, such as those 
described in section 1848(p)(3) of the Social Security 
Act (42 U.S.C. 1395w–4(p)(3)), race, health literacy, 
limited English proficiency (LEP), and Medicare bene-
ficiary activation, on quality measures and resource 
use and other measures under the Medicare program 
(such as to recognize that less healthy individuals may 
require more intensive interventions). In conducting 
such study the Secretary may use existing Federal 
data and collect such additional data as may be nec-
essary to complete the study. 
(ii) REPORT.—Not later than 5 years after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under 
clause (i). 
(C) EXAMINATION OF DATA IN CONDUCTING STUDIES.— 
In conducting the studies under subparagraphs (A) and 
(B), the Secretary shall examine what non-Medicare data 
sets, such as data from the American Community Survey 
(ACS), can be useful in conducting the types of studies 
under such paragraphs and how such data sets that are 
identified as useful can be coordinated with Medicare 
administrative data in order to improve the overall data 
set available to do such studies and for the administration 
of the Medicare program. 
(D) RECOMMENDATIONS TO ACCOUNT FOR INFORMATION 
IN PAYMENT ADJUSTMENT MECHANISMS.—If the studies con-
ducted under subparagraphs (A) and (B) find a relationship 
between the factors examined in the studies and quality 
measures and resource use and other measures, then the 
Secretary shall also provide recommendations for how the 
Centers for Medicare & Medicaid Services should— 
(i) obtain access to the necessary data (if such 
data is not already being collected) on such factors, 
including recommendations on how to address barriers 
to the Centers in accessing such data; and 
(ii) account for such factors— 
(I) in quality measures, resource use meas-
ures, and other measures under title XVIII of the 
Social Security Act (including such measures speci-
fied under subsections (c) and (d) of section 1899B 
of such Act, as added by subsection (a)); and 
(II) in determining payment adjustments 
based on such measures in other applicable provi-
sions of such title. 
(E) FUNDING.—There are hereby appropriated to the 
Secretary from the Federal Hospital Insurance Trust Fund 
under section 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical Insurance 
Trust Fund under section 1841 of such Act (42 U.S.C. 
1395t) (in proportions determined appropriate by the Sec-
retary) to carry out this paragraph $6,000,000, to remain 
available until expended.
H. R. 4994—17 
(2) CMS ACTIVITIES.— 
(A) IN
GENERAL.—Taking into account the relevant 
studies conducted and recommendations made in reports 
under paragraph (1) and, as appropriate, other information, 
including information collected before completion of such 
studies and recommendations, the Secretary, on an ongoing 
basis, shall, as the Secretary determines appropriate and 
based on an individual’s health status and other factors— 
(i) assess appropriate adjustments to quality meas-
ures, resource use measures, and other measures under 
title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) (including measures specified in subsections 
(c) and (d) of section 1899B of such Act, as added 
by subsection (a)); and 
(ii) assess and implement appropriate adjustments 
to payments under such title based on measures 
described in clause (i). 
(B) ACCESSING DATA.—The Secretary shall collect or 
otherwise obtain access to the data necessary to carry 
out this paragraph through existing and new data sources. 
(C) PERIODIC ANALYSES.—The Secretary shall carry out 
periodic analyses, at least every 3 years, based on the 
factors referred to in subparagraph (A) so as to monitor 
changes in possible relationships. 
(D) FUNDING.—There are hereby appropriated to the 
Secretary from the Federal Hospital Insurance Trust Fund 
under section 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical Insurance 
Trust Fund under section 1841 of such Act (42 U.S.C. 
1395t) (in proportions determined appropriate by the Sec-
retary) to carry out this paragraph $10,000,000, to remain 
available until expended. 
(3) STRATEGIC PLAN FOR ACCESSING RACE AND ETHNICITY 
DATA.—Not later than 18 months after the date of the enact-
ment of this Act, the Secretary shall develop and report to 
Congress on a strategic plan for collecting or otherwise 
accessing data on race and ethnicity for purposes of specifying 
quality measures and resource use and other measures under 
subsections (c) and (d) of section 1899B of the Social Security 
Act, as added by subsection (a), and, as the Secretary deter-
mines appropriate, other similar provisions of, including pay-
ment adjustments under, title XVIII of such Act (42 U.S.C. 
1395 et seq.). 
SEC. 3. HOSPICE CARE. 
(a) HOSPICE SURVEY REQUIREMENT.— 
(1) IN GENERAL.—Section 1861(dd)(4) of the Social Security 
Act (42 U.S.C. 1395x(dd)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(C) Any entity that is certified as a hospice program shall 
be subject to a standard survey by an appropriate State or local 
survey agency, or an approved accreditation agency, as determined 
by the Secretary, not less frequently than once every 36 months 
beginning 6 months after the date of the enactment of this subpara-
graph and ending September 30, 2025.’’. 
(2) FUNDING.—For purposes of carrying out subparagraph 
(C) of section 1861(dd)(4) of the Social Security Act (42 U.S.C.
H. R. 4994—18 
1395x(dd)(4)), as added by paragraph (1), there shall be trans-
ferred from the Federal Hospital Insurance Trust Fund under 
section 1817 of such Act (42 U.S.C. 1395i) to the Centers 
for Medicare & Medicaid Services Program Management 
Account— 
(A) $25,000,000 for fiscal years 2015 through 2017, 
to be made available for such purposes in equal parts 
for each such fiscal year; and 
(B) $45,000,000 for fiscal years 2018 through 2025, 
to be made available for such purposes in equal parts 
for each such fiscal year. 
(b) HOSPICE PROGRAM ELIGIBILITY RECERTIFICATION TECHNICAL 
CORRECTION TO APPLY LIMITATION ON LIABILITY OF BENEFICIARY 
RULES.—Section 1879 of the Social Security Act (42 U.S.C. 1395pp) 
is amended by adding at the end the following new subsection: 
‘‘(i) The provisions of this section shall apply with respect 
to a denial of a payment under this title by reason of section 
1814(a)(7)(E) in the same manner as such provisions apply with 
respect to a denial of a payment under this title by reason of 
section 1862(a)(1).’’. 
(c) REVISION TO REQUIREMENT FOR MEDICAL REVIEW OF CER-
TAIN HOSPICE CARE.—Section 1814(a)(7) of the Social Security Act 
(42 U.S.C. 1395f(a)(7)) is amended— 
(1) in subparagraph (C), by striking ‘‘and’’ at the end; 
(2) in subparagraph (D), in the matter preceding clause 
(i), by inserting ‘‘(and, in the case of clause (ii), before the 
date of enactment of subparagraph (E))’’ after ‘‘2011’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(E) on and after the date of enactment of this subpara-
graph, in the case of hospice care provided an individual 
for more than 180 days by a hospice program for which 
the number of such cases for such program comprises more 
than a percent (specified by the Secretary) of the total 
number of all cases of individuals provided hospice care 
by the program under this title, the hospice care provided 
to such individual is medically reviewed (in accordance 
with procedures established by the Secretary); and’’. 
(d) UPDATE OF HOSPICE AGGREGATE PAYMENT CAP.—Section 
1814(i)(2)(B) of the Social Security Act (42 U.S.C. 1395f(i)(2)(B)) 
is amended— 
(1) by striking ‘‘(B) For purposes’’ and inserting ‘‘(B)(i) 
Except as provided in clause (ii), for purposes’’; and 
(2) by adding at the end the following: 
‘‘(ii) For purposes of subparagraph (A) for accounting years 
that end after September 30, 2016, and before October 1, 2025, 
the ‘cap amount’ is the cap amount under this subparagraph for 
the preceding accounting year updated by the percentage update 
to payment rates for hospice care under paragraph (1)(C) for serv-
ices furnished during the fiscal year beginning on the October 
1 preceding the beginning of the accounting year (including the 
application of any productivity or other adjustment under clause 
(iv) of that paragraph). 
‘‘(iii) For accounting years that end after September 30, 2025, 
the cap amount shall be computed under clause (i) as if clause 
(ii) had never applied.’’. 
(e) MEDICARE IMPROVEMENT FUND.—Section 1898 of the Social 
Security Act (42 U.S.C. 1395iii) is amended—