121 
‘‘(iii) take into account how clinical 
best practices and clinical practice guide-
lines should be used in the development of 
quality measures. 
‘‘(B) QUALITY DOMAINS.—For purposes of 
this subsection, the term ‘quality domains’ 
means at least the following domains: 
‘‘(i) Clinical care. 
‘‘(ii) Safety. 
‘‘(iii) Care coordination. 
‘‘(iv) Patient and caregiver experience. 
‘‘(v) Population health and preven-
tion. 
‘‘(C) CONSIDERATION.—In developing the 
draft plan under this paragraph, the Secretary 
shall consider— 
‘‘(i) gap analyses conducted by the en-
tity with a contract under section 1890(a) 
or other contractors or entities; 
‘‘(ii) whether measures are applicable 
across health care settings; 
‘‘(iii) clinical practice improvement ac-
tivities 
submitted 
under 
subsection 
(q)(2)(C)(iv) for identifying possible areas 
for future measure development and identi-
122 
fying existing gaps with respect to such 
measures; and 
‘‘(iv) the quality domains applied 
under this subsection. 
‘‘(D) PRIORITIES.—In developing the draft 
plan under this paragraph, the Secretary shall 
give priority to the following types of measures: 
‘‘(i) Outcome measures, including pa-
tient reported outcome and functional sta-
tus measures. 
‘‘(ii) Patient experience measures. 
‘‘(iii) Care coordination measures. 
‘‘(iv) Measures of appropriate use of 
services, including measures of over use. 
‘‘(E) STAKEHOLDER
INPUT.—The Sec-
retary shall accept through March 1, 2016, 
comments on the draft plan posted under para-
graph (1)(A) from the public, including health 
care providers, payers, consumers, and other 
stakeholders. 
‘‘(F) 
FINAL
MEASURE
DEVELOPMENT 
PLAN.—Not later than May 1, 2016, taking 
into account the comments received under this 
subparagraph, the Secretary shall finalize the 
plan and post on the Internet website of the
123 
Centers for Medicare & Medicaid Services an 
operational plan for the development of quality 
measures for use under the applicable provi-
sions. Such plan shall be updated as appro-
priate. 
‘‘(2) CONTRACTS AND OTHER ARRANGEMENTS 
FOR QUALITY MEASURE DEVELOPMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts or other arrangements with 
entities for the purpose of developing, improv-
ing, updating, or expanding in accordance with 
the plan under paragraph (1) quality measures 
for application under the applicable provisions. 
Such entities shall include organizations with 
quality measure development expertise. 
‘‘(B) PRIORITIZATION.— 
‘‘(i) IN
GENERAL.—In entering into 
contracts or other arrangements under 
subparagraph (A), the Secretary shall give 
priority to the development of the types of 
measures described in paragraph (1)(D). 
‘‘(ii) CONSIDERATION.—In selecting 
measures for development under this sub-
section, the Secretary shall consider—
124 
‘‘(I) 
whether 
such 
measures 
would be electronically specified; and 
‘‘(II) clinical practice guidelines 
to the extent that such guidelines 
exist. 
‘‘(3) ANNUAL REPORT BY THE SECRETARY.— 
‘‘(A) IN GENERAL.—Not later than May 1, 
2017, and annually thereafter, the Secretary 
shall post on the Internet website of the Cen-
ters for Medicare & Medicaid Services a report 
on the progress made in developing quality 
measures for application under the applicable 
provisions. 
‘‘(B) REQUIREMENTS.—Each report sub-
mitted pursuant to subparagraph (A) shall in-
clude the following: 
‘‘(i) A description of the Secretary’s 
efforts to implement this paragraph. 
‘‘(ii) With respect to the measures de-
veloped during the previous year— 
‘‘(I) a description of the total 
number of quality measures developed 
and the types of such measures, such 
as an outcome or patient experience 
measure;
125 
‘‘(II) the name of each measure 
developed; 
‘‘(III) the name of the developer 
and steward of each measure; 
‘‘(IV) with respect to each type 
of measure, an estimate of the total 
amount expended under this title to 
develop all measures of such type; and 
‘‘(V) whether the measure would 
be electronically specified. 
‘‘(iii) With respect to measures in de-
velopment at the time of the report— 
‘‘(I) the information described in 
clause (ii), if available; and 
‘‘(II) a timeline for completion of 
the development of such measures. 
‘‘(iv) A description of any updates to 
the plan under paragraph (1) (including 
newly identified gaps and the status of pre-
viously identified gaps) and the inventory 
of measures applicable under the applicable 
provisions. 
‘‘(v) Other information the Secretary 
determines to be appropriate.
126 
‘‘(4) STAKEHOLDER
INPUT.—With respect to 
paragraph (1), the Secretary shall seek stakeholder 
input with respect to— 
‘‘(A) the identification of gaps where no 
quality measures exist, particularly with respect 
to the types of measures described in paragraph 
(1)(D); 
‘‘(B) prioritizing quality measure develop-
ment to address such gaps; and 
‘‘(C) other areas related to quality measure 
development determined appropriate by the Sec-
retary. 
‘‘(5) 
DEFINITION
OF
APPLICABLE
PROVI-
SIONS.—In this subsection, the term ‘applicable pro-
visions’ means the following provisions: 
‘‘(A) Subsection (q)(2)(B)(i). 
‘‘(B) Section 1833(z)(2)(C). 
‘‘(6) FUNDING.—For purposes of carrying out 
this subsection, the Secretary shall provide for the 
transfer, from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841, of 
$15,000,000 to the Centers for Medicare & Medicaid 
Services Program Management Account for each of 
fiscal years 2015 through 2019. Amounts trans-
127 
ferred under this paragraph shall remain available 
through the end of fiscal year 2022. 
‘‘(7) ADMINISTRATION.—Chapter 35 of title 44, 
United States Code, shall not apply to the collection 
of information for the development of quality meas-
ures.’’. 
SEC. 103. ENCOURAGING CARE MANAGEMENT FOR INDI-
VIDUALS WITH CHRONIC CARE NEEDS. 
(a) IN GENERAL.—Section 1848(b) of the Social Se-
curity Act (42 U.S.C. 1395w–4(b)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) ENCOURAGING
CARE
MANAGEMENT
FOR 
INDIVIDUALS WITH CHRONIC CARE NEEDS.— 
‘‘(A) IN GENERAL.—In order to encourage 
the management of care for individuals with 
chronic care needs the Secretary shall, subject 
to subparagraph (B), make payment (as the 
Secretary determines to be appropriate) under 
this section for chronic care management serv-
ices furnished on or after January 1, 2015, by 
a physician (as defined in section 1861(r)(1)), 
physician assistant or nurse practitioner (as de-
fined in section 1861(aa)(5)(A)), clinical nurse 
specialist 
(as 
defined 
in 
section
128 
1861(aa)(5)(B)), or certified nurse midwife (as 
defined in section 1861(gg)(2)). 
‘‘(B) POLICIES RELATING TO PAYMENT.— 
In carrying out this paragraph, with respect to 
chronic care management services, the Sec-
retary shall— 
‘‘(i) make payment to only one appli-
cable provider for such services furnished 
to an individual during a period; 
‘‘(ii) not make payment under sub-
paragraph (A) if such payment would be 
duplicative of payment that is otherwise 
made under this title for such services; and 
‘‘(iii) not require that an annual 
wellness visit (as defined in section 
1861(hhh)) or an initial preventive phys-
ical examination (as defined in section 
1861(ww)) be furnished as a condition of 
payment for such management services.’’. 
(b) EDUCATION AND OUTREACH.— 
(1) CAMPAIGN.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) shall conduct an 
education and outreach campaign to inform
129 
professionals who furnish items and services 
under part B of title XVIII of the Social Secu-
rity Act and individuals enrolled under such 
part of the benefits of chronic care management 
services described in section 1848(b)(8) of the 
Social Security Act, as added by subsection (a), 
and encourage such individuals with chronic 
care needs to receive such services. 
(B) 
REQUIREMENTS.—Such 
campaign 
shall— 
(i) be directed by the Office of Rural 
Health Policy of the Department of Health 
and Human Services and the Office of Mi-
nority Health of the Centers for Medicare 
& Medicaid Services; and 
(ii) focus on encouraging participation 
by underserved rural populations and ra-
cial and ethnic minority populations. 
(2) REPORT.—Not later than December 31, 
2017, the Secretary shall submit to Congress a re-
port on the use of chronic care management services 
described in such section 1848(b)(8) by individuals 
living in rural areas and by racial and ethnic minor-
ity populations. Such report shall—
130 
(A) identify barriers to receiving chronic 
care management services; and 
(B) make recommendations for increasing 
the appropriate use of chronic care manage-
ment services. 
SEC. 104. EMPOWERING BENEFICIARY CHOICES THROUGH 
CONTINUED ACCESS TO INFORMATION ON 
PHYSICIANS’ SERVICES. 
(a) IN GENERAL.—On an annual basis (beginning 
with 2015), the Secretary shall make publicly available, 
in an easily understandable format, information with re-
spect to physicians and, as appropriate, other eligible pro-
fessionals on items and services furnished to Medicare 
beneficiaries under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
(b) TYPE AND MANNER OF INFORMATION.—The in-
formation made available under this section shall be simi-
lar to the type of information in the Medicare Provider 
Utilization and Payment Data: Physician and Other Sup-
plier Public Use File released by the Secretary with re-
spect to 2012 and shall be made available in a manner 
similar to the manner in which the information in such 
file is made available.
131 
(c) REQUIREMENTS.—The information made avail-
able under this section shall include, at a minimum, the 
following: 
(1) Information on the number of services fur-
nished by the physician or other eligible professional 
under part B of title XVIII of the Social Security 
Act (42 U.S.C. 1395j et seq.), which may include in-
formation on the most frequent services furnished or 
groupings of services. 
(2) Information on submitted charges and pay-
ments for services under such part. 
(3) A unique identifier for the physician or 
other eligible professional that is available to the 
public, such as a national provider identifier. 
(d) SEARCHABILITY.—The information made avail-
able under this section shall be searchable by at least the 
following: 
(1) The specialty or type of the physician or 
other eligible professional. 
(2) Characteristics of the services furnished, 
such as volume or groupings of services. 
(3) The location of the physician or other eligi-
ble professional. 
(e) INTEGRATION ON PHYSICIAN COMPARE.—Begin-
ning with 2016, the Secretary shall integrate the informa-
132 
tion made available under this section on Physician Com-
pare. 
(f) DEFINITIONS.—In this section: 
(1) ELIGIBLE PROFESSIONAL; PHYSICIAN; SEC-
RETARY.—The terms ‘‘eligible professional’’, ‘‘physi-
cian’’, and ‘‘Secretary’’ have the meaning given such 
terms in section 10331(i) of Public Law 111–148. 
(2) PHYSICIAN COMPARE.—The term ‘‘Physi-
cian Compare’’ means the Physician Compare Inter-
net website of the Centers for Medicare & Medicaid 
Services (or a successor website). 
SEC. 105. EXPANDING AVAILABILITY OF MEDICARE DATA. 
(a) EXPANDING USES
OF MEDICARE DATA
BY 
QUALIFIED ENTITIES.— 
(1) ADDITIONAL ANALYSES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), to the extent consistent with appli-
cable information, privacy, security, and disclo-
sure laws (including paragraph (3)), notwith-
standing paragraph (4)(B) of section 1874(e) of 
the Social Security Act (42 U.S.C. 1395kk(e)) 
and the second sentence of paragraph (4)(D) of 
such section, beginning July 1, 2016, a quali-
fied entity may use the combined data described 
in paragraph (4)(B)(iii) of such section received
133 
by such entity under such section, and informa-
tion derived from the evaluation described in 
such paragraph (4)(D), to conduct additional 
non-public analyses (as determined appropriate 
by the Secretary) and provide or sell such anal-
yses to authorized users for non-public use (in-
cluding for the purposes of assisting providers 
of services and suppliers to develop and partici-
pate in quality and patient care improvement 
activities, including developing new models of 
care). 
(B) LIMITATIONS WITH RESPECT TO ANAL-
YSES.— 
(i) EMPLOYERS.—Any analyses pro-
vided or sold under subparagraph (A) to 
an 
employer 
described 
in 
paragraph 
(9)(A)(iii) may only be used by such em-
ployer for purposes of providing health in-
surance to employees and retirees of the 
employer. 
(ii) HEALTH INSURANCE ISSUERS.—A 
qualified entity may not provide or sell an 
analysis to a health insurance issuer de-
scribed in paragraph (9)(A)(iv) unless the 
issuer is providing the qualified entity with
134 
data under section 1874(e)(4)(B)(iii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395kk(e)(4)(B)(iii)). 
(2) ACCESS TO CERTAIN DATA.— 
(A) ACCESS.—To the extent consistent 
with applicable information, privacy, security, 
and disclosure laws (including paragraph (3)), 
notwithstanding paragraph (4)(B) of section 
1874(e) of the Social Security Act (42 U.S.C. 
1395kk(e)) and the second sentence of para-
graph (4)(D) of such section, beginning July 1, 
2016, a qualified entity may— 
(i) provide or sell the combined data 
described in paragraph (4)(B)(iii) of such 
section to authorized users described in 
clauses (i), (ii), and (v) of paragraph 
(9)(A) for non-public use, including for the 
purposes described in subparagraph (B); 
or 
(ii) subject to subparagraph (C), pro-
vide Medicare claims data to authorized 
users described in clauses (i), (ii), and (v), 
of paragraph (9)(A) for non-public use, in-
cluding for the purposes described in sub-
paragraph (B).
135 
(B) PURPOSES DESCRIBED.—The purposes 
described in this subparagraph are assisting 
providers of services and suppliers in developing 
and participating in quality and patient care 
improvement activities, including developing 
new models of care. 
(C) MEDICARE
CLAIMS
DATA
MUST
BE 
PROVIDED AT NO COST.—A qualified entity may 
not charge a fee for providing the data under 
subparagraph (A)(ii). 
(3) PROTECTION OF INFORMATION.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), an analysis or data that is 
provided or sold under paragraph (1) or (2) 
shall not contain information that individually 
identifies a patient. 
(B) INFORMATION ON PATIENTS OF THE 
PROVIDER OF SERVICES OR SUPPLIER.—To the 
extent consistent with applicable information, 
privacy, security, and disclosure laws, an anal-
ysis or data that is provided or sold to a pro-
vider of services or supplier under paragraph 
(1) or (2) may contain information that individ-
ually identifies a patient of such provider or 
supplier, including with respect to items and
136 
services furnished to the patient by other pro-
viders of services or suppliers. 
(C) PROHIBITION ON USING ANALYSES OR 
DATA FOR MARKETING PURPOSES.—An author-
ized user shall not use an analysis or data pro-
vided or sold under paragraph (1) or (2) for 
marketing purposes. 
(4) DATA USE AGREEMENT.—A qualified entity 
and an authorized user described in clauses (i), (ii), 
and (v) of paragraph (9)(A) shall enter into an 
agreement regarding the use of any data that the 
qualified entity is providing or selling to the author-
ized user under paragraph (2). Such agreement shall 
describe the requirements for privacy and security of 
the data and, as determined appropriate by the Sec-
retary, any prohibitions on using such data to link 
to other individually identifiable sources of informa-
tion. If the authorized user is not a covered entity 
under the rules promulgated pursuant to the Health 
Insurance Portability and Accountability Act of 
1996, the agreement shall identify the relevant regu-
lations, as determined by the Secretary, that the 
user shall comply with as if it were acting in the ca-
pacity of such a covered entity.
137 
(5) NO
REDISCLOSURE
OF
ANALYSES
OR 
DATA.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), an authorized user that is 
provided or sold an analysis or data under 
paragraph (1) or (2) shall not redisclose or 
make public such analysis or data or any anal-
ysis using such data. 
(B) PERMITTED REDISCLOSURE.—A pro-
vider of services or supplier that is provided or 
sold an analysis or data under paragraph (1) or 
(2) may, as determined by the Secretary, redis-
close such analysis or data for the purposes of 
performance improvement and care coordination 
activities but shall not make public such anal-
ysis or data or any analysis using such data. 
(6) OPPORTUNITY FOR PROVIDERS OF SERV-
ICES AND SUPPLIERS TO REVIEW.—Prior to a quali-
fied entity providing or selling an analysis to an au-
thorized user under paragraph (1), to the extent 
that such analysis would individually identify a pro-
vider of services or supplier who is not being pro-
vided or sold such analysis, such qualified entity 
shall provide such provider or supplier with the op-
portunity to appeal and correct errors in the manner
138 
described in section 1874(e)(4)(C)(ii) of the Social 
Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)). 
(7) ASSESSMENT FOR A BREACH.— 
(A) IN GENERAL.—In the case of a breach 
of a data use agreement under this section or 
section 1874(e) of the Social Security Act (42 
U.S.C. 1395kk(e)), the Secretary shall impose 
an assessment on the qualified entity both in 
the case of— 
(i) an agreement between the Sec-
retary and a qualified entity; and 
(ii) an agreement between a qualified 
entity and an authorized user. 
(B) ASSESSMENT.—The assessment under 
subparagraph (A) shall be an amount up to 
$100 for each individual 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— 
(i) in the case of an agreement de-
scribed in subparagraph (A)(i), for whom 
the Secretary provided data on to the 
qualified entity under paragraph (2); and 
(ii) in the case of an agreement de-
scribed in subparagraph (A)(ii), for whom
139 
the qualified entity provided data on to the 
authorized user under paragraph (2). 
(C) DEPOSIT OF AMOUNTS COLLECTED.— 
Any amounts collected pursuant to this para-
graph shall be deposited in Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841 of the Social Security Act (42 
U.S.C. 1395t). 
(8) ANNUAL
REPORTS.—Any qualified entity 
that provides or sells an analysis or data under 
paragraph (1) or (2) shall annually submit to the 
Secretary a report that includes— 
(A) a summary of the analyses provided or 
sold, including the number of such analyses, the 
number of purchasers of such analyses, and the 
total amount of fees received for such analyses; 
(B) a description of the topics and pur-
poses of such analyses; 
(C) information on the entities who re-
ceived the data under paragraph (2), the uses 
of the data, and the total amount of fees re-
ceived for providing, selling, or sharing the 
data; and 
(D) other information determined appro-
priate by the Secretary.
140 
(9) DEFINITIONS.—In this subsection and sub-
section (b): 
(A) AUTHORIZED USER.—The term ‘‘au-
thorized user’’ means the following: 
(i) A provider of services. 
(ii) A supplier. 
(iii) An employer (as defined in sec-
tion 3(5) of the Employee Retirement In-
surance Security Act of 1974). 
(iv) A health insurance issuer (as de-
fined in section 2791 of the Public Health 
Service Act). 
(v) A medical society or hospital asso-
ciation. 
(vi) Any entity not described in 
clauses (i) through (v) that is approved by 
the Secretary (other than an employer or 
health insurance issuer not described in 
clauses (iii) and (iv), respectively, as deter-
mined by the Secretary). 
(B) PROVIDER
OF
SERVICES.—The term 
‘‘provider of services’’ has the meaning given 
such term in section 1861(u) of the Social Se-
curity Act (42 U.S.C. 1395x(u)).
141 
(C) QUALIFIED ENTITY.—The term ‘‘quali-
fied entity’’ has the meaning given such term in 
section 1874(e)(2) of the Social Security Act 
(42 U.S.C. 1395kk(e)). 
(D) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
(E) SUPPLIER.—The term ‘‘supplier’’ has 
the meaning given such term in section 1861(d) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(d)). 
(b) ACCESS
TO MEDICARE DATA
BY QUALIFIED 
CLINICAL DATA REGISTRIES TO FACILITATE QUALITY 
IMPROVEMENT.— 
(1) ACCESS.— 
(A) IN
GENERAL.—To the extent con-
sistent with applicable information, privacy, se-
curity, and disclosure laws, beginning July 1, 
2016, the Secretary shall, at the request of a 
qualified clinical data registry under section 
1848(m)(3)(E) of the Social Security Act (42 
U.S.C. 1395w–4(m)(3)(E)), provide the data 
described in subparagraph (B) (in a form and 
manner determined to be appropriate) to such 
qualified clinical data registry for purposes of
142 
linking such data with clinical outcomes data 
and performing risk-adjusted, scientifically valid 
analyses and research to support quality im-
provement or patient safety, provided that any 
public reporting of such analyses or research 
that identifies a provider of services or supplier 
shall only be conducted with the opportunity of 
such provider or supplier to appeal and correct 
errors in the manner described in subsection 
(a)(6). 
(B) DATA
DESCRIBED.—The data de-
scribed in this subparagraph is— 
(i) claims data under the Medicare 
program under title XVIII of the Social 
Security Act; and 
(ii) if the Secretary determines appro-
priate, claims data under the Medicaid 
program under title XIX of such Act and 
the State Children’s Health Insurance Pro-
gram under title XXI of such Act. 
(2) FEE.—Data described in paragraph (1)(B) 
shall be provided to a qualified clinical data registry 
under paragraph (1) at a fee equal to the cost of 
providing such data. Any fee collected pursuant to 
the preceding sentence shall be deposited in the Cen-
143 
ters for Medicare & Medicaid Services Program 
Management Account. 
(c) EXPANSION OF DATA AVAILABLE TO QUALIFIED 
ENTITIES.—Section 1874(e) of the Social Security Act 
(42 U.S.C. 1395kk(e)) is amended— 
(1) in the subsection heading, by striking 
‘‘MEDICARE’’; and 
(2) in paragraph (3)— 
(A) by inserting after the first sentence the 
following new sentence: ‘‘Beginning July 1, 
2016, if the Secretary determines appropriate, 
the data described in this paragraph may also 
include standardized extracts (as determined by 
the Secretary) of claims data under titles XIX 
and XXI for assistance provided under such ti-
tles for one or more specified geographic areas 
and time periods requested by a qualified enti-
ty.’’; and 
(B) in the last sentence, by inserting ‘‘or 
under titles XIX or XXI’’ before the period at 
the end. 
(d) REVISION OF PLACEMENT OF FEES.—Section 
1874(e)(4)(A) of the Social Security Act (42 U.S.C. 
1395kk(e)(4)(A)) is amended, in the second sentence—
144 
(1) by inserting ‘‘, for periods prior to July 1, 
2016,’’ after ‘‘deposited’’; and 
(2) by inserting the following before the period 
at the end: ‘‘, and, beginning July 1, 2016, into the 
Centers for Medicare & Medicaid Services Program 
Management Account’’. 
SEC. 
106. 
REDUCING 
ADMINISTRATIVE 
BURDEN 
AND 
OTHER PROVISIONS. 
(a) MEDICARE PHYSICIAN AND PRACTITIONER OPT- 
OUT TO PRIVATE CONTRACT.— 
(1) INDEFINITE, CONTINUING AUTOMATIC EX-
TENSION OF OPT OUT ELECTION.— 
(A) IN GENERAL.—Section 1802(b)(3) of 
the Social Security Act (42 U.S.C. 1395a(b)(3)) 
is amended— 
(i) in subparagraph (B)(ii), by strik-
ing ‘‘during the 2-year period beginning on 
the date the affidavit is signed’’ and insert-
ing ‘‘during the applicable 2-year period 
(as defined in subparagraph (D))’’; 
(ii) in subparagraph (C), by striking 
‘‘during the 2-year period described in sub-
paragraph (B)(ii)’’ and inserting ‘‘during 
the applicable 2-year period’’; and
145 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) APPLICABLE
2-YEAR
PERIODS
FOR 
EFFECTIVENESS OF AFFIDAVITS.—In this sub-
section, the term ‘applicable 2-year period’ 
means, with respect to an affidavit of a physi-
cian or practitioner under subparagraph (B), 
the 2-year period beginning on the date the af-
fidavit is signed and includes each subsequent 
2-year period unless the physician or practi-
tioner involved provides notice to the Secretary 
(in a form and manner specified by the Sec-
retary), not later than 30 days before the end 
of the previous 2-year period, that the physician 
or practitioner does not want to extend the ap-
plication of the affidavit for such subsequent 2- 
year period.’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply to affi-
davits entered into on or after the date that is 
60 days after the date of the enactment of this 
Act. 
(2) PUBLIC AVAILABILITY OF INFORMATION ON 
OPT-OUT PHYSICIANS AND PRACTITIONERS.—Section
146 
1802(b) of the Social Security Act (42 U.S.C. 
1395a(b)) is amended— 
(A) in paragraph (5), by adding at the end 
the following new subparagraph: 
‘‘(D) OPT-OUT PHYSICIAN OR PRACTITIONER.— 
The term ‘opt-out physician or practitioner’ means 
a physician or practitioner who has in effect an affi-
davit under paragraph (3)(B).’’; 
(B) by redesignating paragraph (5) as 
paragraph (6); and 
(C) by inserting after paragraph (4) the 
following new paragraph: 
‘‘(5) POSTING OF INFORMATION ON OPT-OUT 
PHYSICIANS AND PRACTITIONERS.— 
‘‘(A) IN
GENERAL.—Beginning not later 
than February 1, 2016, the Secretary shall 
make publicly available through an appropriate 
publicly accessible website of the Department of 
Health and Human Services information on the 
number and characteristics of opt-out physi-
cians and practitioners and shall update such 
information on such website not less often than 
annually. 
‘‘(B) INFORMATION
TO
BE
INCLUDED.— 
The information to be made available under
147 
subparagraph (A) shall include at least the fol-
lowing with respect to opt-out physicians and 
practitioners: 
‘‘(i) Their number. 
‘‘(ii) Their physician or professional 
specialty or other designation. 
‘‘(iii) Their geographic distribution. 
‘‘(iv) The timing of their becoming 
opt-out physicians and practitioners, rel-
ative, to the extent feasible, to when they 
first enrolled in the program under this 
title and with respect to applicable 2-year 
periods. 
‘‘(v) The proportion of such physi-
cians and practitioners who billed for 
emergency or urgent care services.’’. 
(b) PROMOTING INTEROPERABILITY OF ELECTRONIC 
HEALTH RECORD SYSTEMS.— 
(1) RECOMMENDATIONS FOR ACHIEVING WIDE-
SPREAD EHR INTEROPERABILITY.— 
(A) OBJECTIVE.—As a consequence of a 
significant Federal investment in the implemen-
tation of health information technology through 
the Medicare and Medicaid EHR incentive pro-
grams, Congress declares it a national objective
148 
to achieve widespread exchange of health infor-
mation through interoperable certified EHR 
technology nationwide by December 31, 2018. 
(B) DEFINITIONS.—In this paragraph: 
(i) 
WIDESPREAD
INTEROPER-
ABILITY.—The term ‘‘widespread inter-
operability’’ means interoperability between 
certified EHR technology systems em-
ployed by meaningful EHR users under 
the Medicare and Medicaid EHR incentive 
programs and other clinicians and health 
care providers on a nationwide basis. 
(ii) INTEROPERABILITY.—The term 
‘‘interoperability’’ means the ability of two 
or more health information systems or 
components to exchange clinical and other 
information and to use the information 
that has been exchanged using common 
standards as to provide access to longitu-
dinal information for health care providers 
in order to facilitate coordinated care and 
improved patient outcomes. 
(C) ESTABLISHMENT
OF
METRICS.—Not 
later than July 1, 2016, and in consultation 
with stakeholders, the Secretary shall establish
149 
metrics to be used to determine if and to the 
extent that the objective described in subpara-
graph (A) has been achieved. 
(D) RECOMMENDATIONS
IF
OBJECTIVE 
NOT
ACHIEVED.—If the Secretary of Health 
and Human Services determines that the objec-
tive described in subparagraph (A) has not been 
achieved by December 31, 2018, then the Sec-
retary shall submit to Congress a report, by not 
later than December 31, 2019, that identifies 
barriers to such objective and recommends ac-
tions that the Federal Government can take to 
achieve such objective. Such recommended ac-
tions may include recommendations— 
(i) to adjust payments for not being 
meaningful EHR users under the Medicare 
EHR incentive programs; and 
(ii) for criteria for decertifying cer-
tified EHR technology products. 
(2) PREVENTING BLOCKING THE SHARING OF 
INFORMATION.— 
(A) FOR MEANINGFUL USE EHR PROFES-
SIONALS.—Section 1848(o)(2)(A)(ii) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(o)(2)(A)(ii)) is amended by inserting before
150 
the period at the end the following: ‘‘, and the 
professional demonstrates (through a process 
specified by the Secretary, such as the use of an 
attestation) that the professional has not know-
ingly and willfully taken action (such as to dis-
able functionality) to limit or restrict the com-
patibility or interoperability of the certified 
EHR technology’’. 
(B) FOR
MEANINGFUL
USE
EHR
HOS-
PITALS.—Section 1886(n)(3)(A)(ii) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395ww(n)(3)(A)(ii)) is amended by inserting 
before the period at the end the following: ‘‘, 
and the hospital demonstrates (through a proc-
ess specified by the Secretary, such as the use 
of an attestation) that the hospital has not 
knowingly and willfully taken action (such as to 
disable functionality) to limit or restrict the 
compatibility or interoperability of the certified 
EHR technology’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply to meaning-
ful EHR users as of the date that is one year 
after the date of the enactment of this Act.
151 
(3) STUDY AND REPORT ON THE FEASIBILITY 
OF ESTABLISHING A MECHANISM TO COMPARE CER-
TIFIED EHR TECHNOLOGY PRODUCTS.— 
(A) STUDY.—The Secretary shall conduct 
a study to examine the feasibility of estab-
lishing one or more mechanisms to assist pro-
viders in comparing and selecting certified 
EHR technology products. Such mechanisms 
may include— 
(i) a website with aggregated results 
of surveys of meaningful EHR users on 
the functionality of certified EHR tech-
nology products to enable such users to di-
rectly compare the functionality and other 
features of such products; and 
(ii) information from vendors of cer-
tified products that is made publicly avail-
able in a standardized format. 
The aggregated results of the surveys described 
in clause (i) may be made available through 
contracts with physicians, hospitals, or other or-
ganizations that maintain such comparative in-
formation described in such clause. 
(B) REPORT.—Not later than 1 year after 
the date of the enactment of this Act, the Sec-
152 
retary shall submit to Congress a report on 
mechanisms that would assist providers in com-
paring and selecting certified EHR technology 
products. The report shall include information 
on the benefits of, and resources needed to de-
velop and maintain, such mechanisms. 
(4) DEFINITIONS.—In this subsection: 
(A) The term ‘‘certified EHR technology’’ 
has the meaning given such term in section 
1848(o)(4) of the Social Security Act (42 
U.S.C. 1395w–4(o)(4)). 
(B) The term ‘‘meaningful EHR user’’ has 
the meaning given such term under the Medi-
care EHR incentive programs. 
(C) The term ‘‘Medicare and Medicaid 
EHR incentive programs’’ means— 
(i) in the case of the Medicare pro-
gram under title XVIII of the Social Secu-
rity Act, the incentive programs under sec-
tion 1814(l)(3), section 1848(o), sub-
sections (l) and (m) of section 1853, and 
section 1886(n) of the Social Security Act 
(42 
U.S.C. 
1395f(l)(3), 
1395w–4(o), 
1395w–23, 1395ww(n)); and
153 
(ii) in the case of the Medicaid pro-
gram under title XIX of such Act, the in-
centive 
program 
under 
subsections 
(a)(3)(F) and (t) of section 1903 of such 
Act (42 U.S.C. 1396b). 
(D) The term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services. 
(c) GAO STUDIES AND REPORTS ON THE USE OF 
TELEHEALTH UNDER FEDERAL PROGRAMS AND ON RE-
MOTE PATIENT MONITORING SERVICES.— 
(1) STUDY ON TELEHEALTH SERVICES.—The 
Comptroller General of the United States shall con-
duct a study on the following: 
(A) How the definition of telehealth across 
various Federal programs and Federal efforts 
can inform the use of telehealth in the Medicare 
program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(B) Issues that can facilitate or inhibit the 
use of telehealth under the Medicare program 
under such title, including oversight and profes-
sional licensure, changing technology, privacy 
and security, infrastructure requirements, and 
varying needs across urban and rural areas.
154 
(C) Potential implications of greater use of 
telehealth with respect to payment and delivery 
system transformations under the Medicare 
program under such title XVIII and the Med-
icaid program under title XIX of such Act (42 
U.S.C. 1396 et seq.). 
(D) How the Centers for Medicare & Med-
icaid Services monitors payments made under 
the Medicare program under such title XVIII to 
providers for telehealth services. 
(2) STUDY ON REMOTE PATIENT MONITORING 
SERVICES.— 
(A) IN GENERAL.—The Comptroller Gen-
eral of the United States shall conduct a 
study— 
(i) of the dissemination of remote pa-
tient monitoring technology in the private 
health insurance market; 
(ii) of the financial incentives in the 
private health insurance market relating to 
adoption of such technology; 
(iii) of the barriers to adoption of 
such services under the Medicare program 
under title XVIII of the Social Security 
Act;
155 
(iv) that evaluates the patients, condi-
tions, and clinical circumstances that could 
most benefit from remote patient moni-
toring services; and 
(v) that evaluates the challenges re-
lated to establishing appropriate valuation 
for remote patient monitoring services 
under the Medicare physician fee schedule 
under section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) in order to accu-
rately reflect the resources involved in fur-
nishing such services. 
(B) DEFINITIONS.—For purposes of this 
paragraph: 
(i) REMOTE
PATIENT
MONITORING 
SERVICES.—The term ‘‘remote patient 
monitoring services’’ means services fur-
nished through remote patient monitoring 
technology. 
(ii) REMOTE
PATIENT
MONITORING 
TECHNOLOGY.—The term ‘‘remote patient 
monitoring technology’’ means a coordi-
nated system that uses one or more home- 
based or mobile monitoring devices that 
automatically transmit vital sign data or
156 
information on activities of daily living and 
may include responses to assessment ques-
tions collected on the devices wirelessly or 
through a telecommunications connection 
to a server that complies with the Federal 
regulations (concerning the privacy of indi-
vidually identifiable health information) 
promulgated under section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996, as part of an estab-
lished plan of care for that patient that in-
cludes the review and interpretation of that 
data by a health care professional. 
(3) REPORTS.—Not later than 24 months after 
the date of the enactment of this Act, the Comp-
troller General shall submit to Congress— 
(A) a report containing the results of the 
study conducted under paragraph (1); and 
(B) a report containing the results of the 
study conducted under paragraph (2). 
A report required under this paragraph shall be sub-
mitted together with recommendations for such leg-
islation and administrative action as the Comptroller 
General determines appropriate. The Comptroller 
General may submit one report containing the re-
157 
sults described in subparagraphs (A) and (B) and 
the recommendations described in the previous sen-
tence. 
(d) RULE OF CONSTRUCTION REGARDING HEALTH 
CARE PROVIDERS.— 
(1) IN GENERAL.—Subject to paragraph (3), 
the development, recognition, or implementation of 
any guideline or other standard under any Federal 
health care provision shall not be construed to estab-
lish the standard of care or duty of care owed by a 
health care provider to a patient in any medical mal-
practice or medical product liability action or claim. 
(2) DEFINITIONS.—For purposes of this sub-
section: 
(A) FEDERAL HEALTH CARE PROVISION.— 
The term ‘‘Federal health care provision’’ 
means any provision of the Patient Protection 
and Affordable Care Act (Public Law 111– 
148), title I or subtitle B of title II of the 
Health Care and Education Reconciliation Act 
of 2010 (Public Law 111–152), or title XVIII 
or XIX of the Social Security Act (42 U.S.C. 
1395 et seq., 42 U.S.C. 1396 et seq.). 
(B) HEALTH CARE PROVIDER.—The term 
‘‘health care provider’’ means any individual,
158 
group practice, corporation of health care pro-
fessionals, or hospital— 
(i) licensed, registered, or certified 
under Federal or State laws or regulations 
to provide health care services; or 
(ii) required to be so licensed, reg-
istered, or certified but that is exempted 
by other statute or regulation. 
(C) MEDICAL MALPRACTICE OR MEDICAL 
PRODUCT
LIABILITY
ACTION
OR
CLAIM.—The 
term ‘‘medical malpractice or medical product 
liability action or claim’’ means a medical mal-
practice action or claim (as defined in section 
431(7) of the Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11151(7))) and 
includes a liability action or claim relating to a 
health care provider’s prescription or provision 
of a drug, device, or biological product (as such 
terms are defined in section 201 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 321) 
or section 351 of the Public Health Service Act 
(42 U.S.C. 262)). 
(D) STATE.—The term ‘‘State’’ includes 
the District of Columbia, Puerto Rico, and any
159 
other commonwealth, possession, or territory of 
the United States. 
(3) NO
PREEMPTION.—Nothing in paragraph 
(1) or any provision of the Patient Protection and 
Affordable Care Act (Public Law 111–148), title I 
or subtitle B of title II of the Health Care and Edu-
cation Reconciliation Act of 2010 (Public Law 111– 
152), or title XVIII or XIX of the Social Security 
Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et 
seq.) shall be construed to preempt any State or 
common law governing medical professional or med-
ical product liability actions or claims. 
TITLE II—MEDICARE AND 
OTHER HEALTH EXTENDERS 
Subtitle A—Medicare Extenders 
SEC. 201. 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 ‘‘April 
1, 2015’’ and inserting ‘‘January 1, 2018’’. 
SEC. 202. EXTENSION OF THERAPY CAP EXCEPTIONS PROC-
ESS. 
(a) IN GENERAL.—Section 1833(g) of the Social Se-
curity Act (42 U.S.C. 1395l(g)) is amended—
160 
(1) in paragraph (5)(A), in the first sentence, 
by striking ‘‘March 31, 2015’’ and inserting ‘‘De-
cember 31, 2017’’; and 
(2) in paragraph (6)(A)— 
(A) by striking ‘‘March 31, 2015’’ and in-
serting ‘‘December 31, 2017’’; and 
(B) by striking ‘‘2012, 2013, 2014, or the 
first three months of 2015’’ and inserting 
‘‘2012 through 2017’’. 
(b) TARGETED REVIEWS UNDER MANUAL MEDICAL 
REVIEW PROCESS
FOR OUTPATIENT THERAPY SERV-
ICES.— 
(1) IN GENERAL.—Section 1833(g)(5) of the 
Social Security Act (42 U.S.C. 1395l(g)(5)) is 
amended— 
(A) in subparagraph (C)(i), by inserting ‘‘, 
subject to subparagraph (E),’’ after ‘‘manual 
medical review process that’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(E)(i) In place of the manual medical review process 
under subparagraph (C)(i), the Secretary shall implement 
a process for medical review under this subparagraph 
under which the Secretary shall identify and conduct med-
ical review for services described in subparagraph (C)(i)
161 
furnished by a provider of services or supplier (in this sub-
paragraph referred to as a ‘therapy provider’) using such 
factors as the Secretary determines to be appropriate. 
‘‘(ii) Such factors may include the following: 
‘‘(I) The therapy provider has had a high 
claims denial percentage for therapy services under 
this part or is less compliant with applicable require-
ments under this title. 
‘‘(II) The therapy provider has a pattern of bill-
ing for therapy services under this part that is aber-
rant compared to peers or otherwise has question-
able billing practices for such services, such as bill-
ing medically unlikely units of services in a day. 
‘‘(III) The therapy provider is newly enrolled 
under this title or has not previously furnished ther-
apy services under this part. 
‘‘(IV) The services are furnished to treat a type 
of medical condition. 
‘‘(V) The therapy provider is part of group that 
includes another therapy provider identified using 
the factors determined under this subparagraph. 
‘‘(iii) For purposes of carrying out this subparagraph, 
the Secretary shall provide for the transfer, from the Fed-
eral Supplementary Medical Insurance Trust Fund under 
section 1841, of $5,000,000 to the Centers for Medicare
162 
& Medicaid Services Program Management Account for 
fiscal years 2015 and 2016, to remain available until ex-
pended. Such funds may not be used by a contractor under 
section 1893(h) for medical reviews under this subpara-
graph. 
‘‘(iv) The targeted review process under this subpara-
graph shall not apply to services for which expenses are 
incurred beyond the period for which the exceptions proc-
ess under subparagraph (A) is implemented.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to re-
quests described in section 1833(g)(5)(C)(i) of the 
Social Security Act (42 U.S.C. 1395l(g)(5)(C)(i)) 
with respect to which the Secretary of Health and 
Human Services has not conducted medical review 
under such section by a date (not later than 90 days 
after the date of the enactment of this Act) specified 
by the Secretary. 
SEC. 203. EXTENSION OF AMBULANCE ADD-ONS. 
(a) GROUND AMBULANCE.—Section 1834(l)(13)(A) 
of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) 
is amended by striking ‘‘April 1, 2015’’ and inserting 
‘‘January 1, 2018’’ each place it appears. 
(b) SUPER RURAL GROUND AMBULANCE.—Section 
1834(l)(12)(A) of the Social Security Act (42 U.S.C.
163 
1395m(l)(12)(A)) is amended, in the first sentence, by 
striking ‘‘April 1, 2015’’ and inserting ‘‘January 1, 
2018’’. 
SEC. 204. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
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 ‘‘in fiscal year 2015 
(beginning on April 1, 2015), fiscal year 2016, and 
subsequent fiscal years’’ and inserting ‘‘in fiscal year 
2018 and subsequent fiscal years’’; 
(2) in subparagraph (C)(i), by striking ‘‘fiscal 
years 2011 through 2014 and fiscal year 2015 (be-
fore April 1, 2015),’’ and inserting ‘‘fiscal years 
2011 through 2017,’’ each place it appears; and 
(3) in subparagraph (D), by striking ‘‘fiscal 
years 2011 through 2014 and fiscal year 2015 (be-
fore April 1, 2015),’’ and inserting ‘‘fiscal years 
2011 through 2017,’’.
164 
SEC. 205. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
(1) in clause (i), by striking ‘‘April 1, 2015’’ 
and inserting ‘‘October 1, 2017’’; and 
(2) in clause (ii)(II), by striking ‘‘April 1, 
2015’’ and inserting ‘‘October 1, 2017’’. 
(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 ‘‘April 1, 2015’’ and inserting ‘‘October 
1, 2017’’; and 
(B) in clause (iv), by striking ‘‘through fis-
cal year 2014 and the portion of fiscal year 
2015 before April 1, 2015’’ and inserting 
‘‘through fiscal year 2017’’. 
(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 the 
first 2 quarters of fiscal year 2015’’ and inserting 
‘‘through fiscal year 2017’’.
165 
SEC. 206. EXTENSION FOR SPECIALIZED MEDICARE ADVAN-
TAGE PLANS FOR SPECIAL NEEDS INDIVID-
UALS. 
Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘2017’’ 
and inserting ‘‘2019’’. 
SEC. 207. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended by striking ‘‘and 
$15,000,000 for the first 6 months of fiscal year 2015’’ 
and inserting ‘‘and $30,000,000 for each of fiscal years 
2015 through 2017’’. 
SEC. 208. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH IN-
SURANCE PROGRAMS.—Subsection (a)(1)(B) of section 
119 of the Medicare Improvements for Patients and Pro-
viders 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), section 610 of the Amer-
ican Taxpayer Relief Act of 2012 (Public Law 112–240), 
section 1110 of the Pathway for SGR Reform Act of 2013 
(Public Law 113–67), and section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113–93), is 
amended—
166 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by adding at the end the following new 
clauses: 
‘‘(v) 
for 
fiscal 
year 
2015, 
of 
$7,500,000; 
‘‘(vi) 
for 
fiscal 
year 
2016, 
of 
$13,000,000; and 
‘‘(vii) 
for 
fiscal 
year 
2017, 
of 
$13,000,000.’’. 
(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 
AGING.—Subsection (b)(1)(B) of such section 119, as so 
amended, is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following 
new clauses: 
‘‘(v) 
for 
fiscal 
year 
2015, 
of 
$7,500,000; 
‘‘(vi) 
for 
fiscal 
year 
2016, 
of 
$7,500,000; and 
‘‘(vii) 
for 
fiscal 
year 
2017, 
of 
$7,500,000.’’.
167 
(c) ADDITIONAL FUNDING
FOR AGING
AND DIS-
ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 
such section 119, as so amended, is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following 
new clauses: 
‘‘(v) 
for 
fiscal 
year 
2015, 
of 
$5,000,000; 
‘‘(vi) 
for 
fiscal 
year 
2016, 
of 
$5,000,000; and 
‘‘(vii) 
for 
fiscal 
year 
2017, 
of 
$5,000,000.’’. 
(d) ADDITIONAL FUNDING
FOR CONTRACT WITH 
THE NATIONAL CENTER FOR BENEFITS AND OUTREACH 
ENROLLMENT.—Subsection (d)(2) of such section 119, as 
so amended, is amended— 
(1) in clause (iv), by striking ‘‘and’’ at the end; 
(2) by striking clause (v); and 
(3) by inserting after clause (iv) the following 
new clauses: 
‘‘(v) 
for 
fiscal 
year 
2015, 
of 
$5,000,000; 
‘‘(vi) 
for 
fiscal 
year 
2016, 
of 
$12,000,000; and
168 
‘‘(vii) 
for 
fiscal 
year 
2017, 
of 
$12,000,000.’’. 
SEC. 209. EXTENSION AND TRANSITION OF REASONABLE 
COST REIMBURSEMENT CONTRACTS. 
(a) ONE-YEAR TRANSITION AND NOTICE REGARDING 
TRANSITION.—Section 1876(h)(5)(C) of the Social Secu-
rity Act (42 U.S.C. 1395mm(h)(5)(C)) is amended— 
(1) in clause (ii), in the matter preceding sub-
clause (I), by striking ‘‘For any’’ and inserting 
‘‘Subject to clause (iv), for any’’; 
(2) in clause (iii)(I), by inserting ‘‘cost plan 
service’’ after ‘‘With respect to any portion of the’’; 
(3) in clause (iii)(II), by inserting ‘‘cost plan 
service’’ after ‘‘With respect to any other portion of 
such’’; and 
(4) by adding at the end the following new 
clauses: 
‘‘(iv) In the case of an eligible organization that is 
offering a reasonable cost reimbursement contract that 
may no longer be extended or renewed because of the ap-
plication of clause (ii), or where such contract has been 
extended or renewed but the eligible organization has in-
formed the Secretary in writing not later than a date de-
termined appropriate by the Secretary that such organiza-
169 
tion voluntarily plans not to seek renewal of the reasonable 
cost reimbursement contract, the following shall apply: 
‘‘(I) Notwithstanding such clause, such contract 
may be extended or renewed for the two years subse-
quent to 2016. The final year in which such contract 
is extended or renewed is referred to in this sub-
section as the ‘last reasonable cost reimbursement 
contract year for the contract’. 
‘‘(II) The organization may not enroll a new en-
rollee under such contract during the last reasonable 
cost reimbursement contract year for the contract 
(but may continue to enroll new enrollees through 
the end of the year immediately preceding such 
year) unless such enrollee is any of the following: 
‘‘(aa) An individual who chooses enroll-
ment in the reasonable cost contract during the 
annual election period with respect to such last 
year. 
‘‘(bb) An individual whose spouse, at the 
time of the individual’s enrollment is an enrollee 
under the reasonable cost reimbursement con-
tract. 
‘‘(cc) An individual who is covered under 
an employer group health plan that offers cov-
170 
erage through the reasonable cost reimburse-
ment contract. 
‘‘(dd) An individual who becomes entitled 
to benefits under part A, or enrolled under part 
B, and was enrolled in a plan offered by the eli-
gible organization immediately prior to the indi-
vidual’s enrollment under the reasonable cost 
reimbursement contract. 
‘‘(III) Not later than a date determined appro-
priate by the Secretary prior to the beginning of the 
last reasonable cost reimbursement contract year for 
the contract, the organization shall provide notice to 
the Secretary as to whether the organization will 
apply to have the contract converted over, in whole 
or in part, and offered as a Medicare Advantage 
plan under part C for the year following the last rea-
sonable cost reimbursement contract year for the 
contract. 
‘‘(IV) If the organization provides the notice de-
scribed in subclause (III) that the contract will be 
converted, in whole or in part, the organization 
shall, not later than a date determined appropriate 
by the Secretary, provide the Secretary with such in-
formation as the Secretary determines appropriate 
in order to carry out section 1851(c)(4) and to carry
171 
out section 1854(a)(5), including subparagraph 
(C)(ii) of such section. 
‘‘(V) In the case that the organization enrolls a 
new enrollee under such contract during the last rea-
sonable cost reimbursement contract year for the 
contract, the organization shall provide the indi-
vidual with a notification that such year is the last 
year for such contract. 
‘‘(v) If an eligible organization that is offering a rea-
sonable cost reimbursement contract that is extended or 
renewed pursuant to clause (iv) provides the notice de-
scribed in clause (iv)(III) that the contract will be con-
verted, in whole or in part, the following shall apply: 
‘‘(I) The deemed enrollment under section 
1851(c)(4). 
‘‘(II) The special rule for quality increase under 
section 1853(o)(4)(C). 
‘‘(III) During the last reasonable cost reim-
bursement contract year for the contract and the 
year immediately preceding such year, the eligible 
organization, or the corporate parent organization of 
the eligible organization, shall be permitted to offer 
an MA plan in the area that such contract is being 
offered and enroll Medicare Advantage eligible indi-
viduals in such MA plan and such cost plan.’’.
172 
(b) DEEMED
ENROLLMENT
FROM
REASONABLE 
COST
REIMBURSEMENT
CONTRACTS
CONVERTED
TO 
MEDICARE ADVANTAGE PLANS.— 
(1) IN GENERAL.—Section 1851(c) of the So-
cial Security Act (42 U.S.C. 1395w–21(c)) is 
amended— 
(A) in paragraph (1), by striking ‘‘Such 
elections’’ and inserting ‘‘Subject to paragraph 
(4), such elections’’; and 
(B) by adding at the end the following: 
‘‘(4) DEEMED ENROLLMENT RELATING TO CON-
VERTED REASONABLE COST REIMBURSEMENT CON-
TRACTS.— 
‘‘(A) IN GENERAL.—On the first day of 
the annual, coordinated election period under 
subsection (e)(3) for plan years beginning on or 
after January 1, 2017, an MA eligible indi-
vidual described in clause (i) or (ii) of subpara-
graph (B) is deemed, unless the individual 
elects otherwise, to have elected to receive bene-
fits under this title through an applicable MA 
plan (and shall be enrolled in such plan) begin-
ning with such plan year, if—
173 
‘‘(i) the individual is enrolled in a rea-
sonable cost reimbursement contract under 
section 1876(h) in the previous plan year; 
‘‘(ii) such reasonable cost reimburse-
ment contract was extended or renewed for 
the last reasonable cost reimbursement 
contract year of the contract (as described 
in 
subclause 
(I) 
of 
section 
1876(h)(5)(C)(iv)) pursuant to such sec-
tion; 
‘‘(iii) the eligible organization that is 
offering such reasonable cost reimburse-
ment contract provided the notice de-
scribed in subclause (III) of such section 
that the contract was to be converted; 
‘‘(iv) the applicable MA plan— 
‘‘(I) is the plan that was con-
verted from the reasonable cost reim-
bursement 
contract 
described 
in 
clause (iii); 
‘‘(II) is offered by the same enti-
ty (or an organization affiliated with 
such entity that has a common owner-
ship interest of control) that entered 
into such contract; and
174 
‘‘(III) is offered in the service 
area where the individual resides; 
‘‘(v) in the case of reasonable cost re-
imbursement contracts that provide cov-
erage under parts A and B (and, to the ex-
tent the Secretary determines it to be fea-
sible, contracts that provide only part B 
coverage), the difference between the esti-
mated individual costs (as determined ap-
plicable by the Secretary) for the applica-
ble MA plan and such costs for the prede-
cessor cost plan does not exceed a thresh-
old established by the Secretary; and 
‘‘(vi) the applicable MA plan— 
‘‘(I) provides coverage for enroll-
ees transitioning from the converted 
reasonable cost reimbursement con-
tract to such plan to maintain current 
providers of services and suppliers 
and course of treatment at the time of 
enrollment for a period of at least 90 
days after enrollment; and 
‘‘(II) during such period, pays 
such providers of services and sup-
pliers for items and services furnished
175 
to the enrollee an amount that is not 
less than the amount of payment ap-
plicable for such items and services 
under the original Medicare fee-for- 
service program under parts A and B. 
‘‘(B) MA 
ELIGIBLE
INDIVIDUALS
DE-
SCRIBED.— 
‘‘(i) WITHOUT
PRESCRIPTION
DRUG 
COVERAGE.—An MA eligible individual de-
scribed in this clause, with respect to a 
plan year, is an MA eligible individual who 
is enrolled in a reasonable cost reimburse-
ment contract under section 1876(h) in the 
previous plan year and who is not, for such 
previous plan year, enrolled in a prescrip-
tion drug plan under part D, including 
coverage under section 1860D–22. 
‘‘(ii) WITH PRESCRIPTION DRUG COV-
ERAGE.—An MA eligible individual de-
scribed in this clause, with respect to a 
plan year, is an MA eligible individual who 
is enrolled in a reasonable cost reimburse-
ment contract under section 1876(h) in the 
previous plan year and who, for such pre-
176 
vious plan year, is enrolled in a prescrip-
tion drug plan under part D— 
‘‘(I) through such contract; or 
‘‘(II) through a prescription drug 
plan, if the sponsor of such plan is the 
same entity (or an organization affili-
ated with such entity) that entered 
into such contract. 
‘‘(C) APPLICABLE MA PLAN DEFINED.—In 
this paragraph, the term ‘applicable MA plan’ 
means, in the case of an individual described 
in— 
‘‘(i) subparagraph (B)(i), an MA plan 
that is not an MA–PD plan; and 
‘‘(ii) subparagraph (B)(ii), an MA– 
PD plan. 
‘‘(D) IDENTIFICATION AND NOTIFICATION 
OF DEEMED INDIVIDUALS.—Not later than 45 
days before the first day of the annual, coordi-
nated election period under subsection (e)(3) 
for plan years beginning on or after January 1, 
2017, the Secretary shall identify and notify the 
individuals who will be subject to deemed elec-
tions under subparagraph (A) on the first day 
of such period.’’.
177 
(2) BENEFICIARY OPTION TO DISCONTINUE OR 
CHANGE MA PLAN OR MA–PD PLAN AFTER DEEMED 
ENROLLMENT.— 
(A) IN GENERAL.—Section 1851(e)(2) of 
the Social Security Act (42 U.S.C. 1395w– 
21(e)(4)) is amended by adding at the end the 
following: 
‘‘(F) 
SPECIAL
PERIOD
FOR
CERTAIN 
DEEMED ELECTIONS.— 
‘‘(i) IN GENERAL.—At any time dur-
ing the period beginning after the last day 
of the annual, coordinated election period 
under paragraph (3) in which an individual 
is deemed to have elected to enroll in an 
MA plan or MA–PD plan under subsection 
(c)(4) and ending on the last day of Feb-
ruary of the first plan year for which the 
individual is enrolled in such plan, such in-
dividual may change the election under 
subsection (a)(1) (including changing the 
MA plan or MA–PD plan in which the in-
dividual is enrolled). 
‘‘(ii) LIMITATION OF ONE CHANGE.— 
An individual may exercise the right under 
clause (i) only once during the applicable
178 
period described in such clause. The limita-
tion under this clause shall not apply to 
changes in elections effected during an an-
nual, coordinated election period under 
paragraph (3) or during a special enroll-
ment period under paragraph (4).’’. 
(B) CONFORMING AMENDMENTS.— 
(i) PLAN
REQUIREMENT
FOR
OPEN 
ENROLLMENT.—Section 1851(e)(6)(A) of 
the Social Security Act (42 U.S.C. 1395w– 
21(e)(6)(A)) is amended by striking ‘‘para-
graph (1),’’ and inserting ‘‘paragraph (1), 
during the period described in paragraph 
(2)(F),’’. 
(ii) 
PART
D.—Section 
1860D– 
1(b)(1)(B) of such Act (42 U.S.C. 1395w– 
101(b)(1)(B)) is amended— 
(I) in clause (ii), by adding ‘‘and 
paragraph 
(4)’’ 
after 
‘‘paragraph 
(3)(A)’’; and 
(II) in clause (iii) by striking 
‘‘and (E)’’ and inserting ‘‘(E), and 
(F)’’. 
(3) TREATMENT OF ESRD FOR DEEMED EN-
ROLLMENT.—Section 1851(a)(3)(B) of the Social
179 
Security Act (42 U.S.C. 1395w–21(a)(3)(B)) is 
amended by adding at the end the following flush 
sentence: ‘‘An individual who develops end-stage 
renal disease while enrolled in a reasonable cost re-
imbursement contract under section 1876(h) shall be 
treated as an MA eligible individual for purposes of 
applying the deemed enrollment under subsection 
(c)(4).’’. 
(c) 
INFORMATION
REQUIREMENTS.—Section 
1851(d)(2)(B) of the Social Security Act (42 U.S.C. 
1395w–21(d)(2)(B)) is amended— 
(1) in the heading, by striking ‘‘NOTIFICATION 
TO NEWLY ELIGIBLE MEDICARE ADVANTAGE ELIGI-
BLE INDIVIDUALS’’ and inserting the following: ‘‘NO-
TIFICATIONS REQUIRED.— 
‘‘(i) NOTIFICATION TO NEWLY ELIGI-
BLE MEDICARE ADVANTAGE ELIGIBLE IN-
DIVIDUALS.—’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) NOTIFICATION RELATED TO CER-
TAIN DEEMED ELECTIONS.—The Secretary 
shall require a Medicare Advantage organi-
zation that is offering a Medicare Advan-
tage plan that has been converted from a
180 
reasonable cost reimbursement contract 
pursuant to section 1876(h)(5)(C)(iv) to 
mail, not later than 30 days prior to the 
first day of the annual, coordinated elec-
tion period under subsection (e)(3) of a 
year, to any individual enrolled under such 
contract and identified by the Secretary 
under subsection (c)(4)(D) for such year— 
‘‘(I) a notification that such indi-
vidual will, on such day, be deemed to 
have made an election with respect to 
such plan to receive benefits under 
this title through an MA plan or MA– 
PD plan (and shall be enrolled in such 
plan) for the next plan year under 
subsection (c)(4)(A), but that the in-
dividual may make a different election 
during the annual, coordinated elec-
tion period for such year; 
‘‘(II) the information described in 
subparagraph (A); 
‘‘(III) a description of the dif-
ferences between such MA plan or 
MA–PD plan and the reasonable cost 
reimbursement contract in which the
181 
individual was most recently enrolled 
with respect to benefits covered under 
such plans, including cost-sharing, 
premiums, drug coverage, and pro-
vider networks; 
‘‘(IV) information about the spe-
cial period for elections under sub-
section (e)(2)(F); and 
‘‘(V) other information the Sec-
retary may specify.’’. 
(d) TREATMENT OF TRANSITION PLAN FOR QUALITY 
RATING FOR PAYMENT PURPOSES.—Section 1853(o)(4) 
of the Social Security Act (42 U.S.C. 1395w–23(o)(4)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(C) SPECIAL
RULE
FOR
FIRST
PLAN 
YEARS
FOR
PLANS
THAT
WERE
CONVERTED 
FROM
A
REASONABLE
COST
REIMBURSEMENT 
CONTRACT.—For purposes of applying para-
graph (1) and section 1854(b)(1)(C) for the 
first 3 plan years under this part in the case of 
an MA plan to which deemed enrollment applies 
under section 1851(c)(4)—
182 
‘‘(i) such plan shall not be treated as 
a new MA plan (as defined in paragraph 
(3)(A)(iii)(II)); and 
‘‘(ii) in determining the star rating of 
the plan under subparagraph (A), to the 
extent that Medicare Advantage data for 
such plan is not available for a measure 
used to determine such star rating, the 
Secretary shall use data from the period in 
which such plan was a reasonable cost re-
imbursement contract.’’. 
SEC. 210. EXTENSION OF HOME HEALTH RURAL ADD-ON. 
Section 421(a) 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) and by sec-
tion 3131(c) of the Patient Protection and Affordable 
Care Act (Public Law 111–148; 124 Stat. 428), is amend-
ed by striking ‘‘January 1, 2016’’ and inserting ‘‘January 
1, 2018’’ each place it appears.
183 
Subtitle B—Other Health 
Extenders 
SEC. 211. PERMANENT EXTENSION OF THE QUALIFYING IN-
DIVIDUAL (QI) PROGRAM. 
(a) 
PERMANENT
EXTENSION.—Section 
1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(E)(iv)) is amended by striking ‘‘(but only 
for premiums payable with respect to months during the 
period beginning with January 1998, and ending with 
March 2015)’’. 
(b) ALLOCATIONS.—Section 1933(g) of the Social Se-
curity Act (42 U.S.C. 1396u–3(g)) is amended— 
(1) in paragraph (2)— 
(A) by striking subparagraphs (A) through 
(H); 
(B) in subparagraph (V), by striking 
‘‘and’’ at the end; 
(C) in subparagraph (W), by striking the 
period at the end and inserting a semicolon; 
(D) by redesignating subparagraphs (I) 
through (W) as subparagraphs (A) through 
(O), respectively; and 
(E) by adding at the end the following new 
subparagraphs:
184 
‘‘(P) for the period that begins on April 1, 
2015, and ends on December 31, 2015, the 
total allocation amount is $535,000,000; and 
‘‘(Q) for 2016 and, subject to paragraph 
(4), for each subsequent year, the total alloca-
tion amount is $980,000,000.’’; 
(2) in paragraph (3), by striking ‘‘(P), (R), (T), 
or (V)’’ and inserting ‘‘or (P)’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(4) ADJUSTMENT
TO
ALLOCATIONS.—The 
Secretary may increase the allocation amount under 
paragraph (2)(Q) for a year (beginning with 2017) 
up to an amount that does not exceed the product 
of the following: 
‘‘(A) MAXIMUM ALLOCATION AMOUNT FOR 
PREVIOUS YEAR.—In the case of 2017, the allo-
cation amount for 2016, or in the case of a sub-
sequent year, the maximum allocation amount 
allowed under this paragraph for the previous 
year. 
‘‘(B) INCREASE
IN
PART
B
PREMIUM.— 
The monthly premium rate determined under 
section 1839 for the year divided by the month-
185 
ly premium rate determined under such section 
for the previous year. 
‘‘(C) INCREASE
IN
PART
B
ENROLL-
MENT.—The average number of individuals (as 
estimated by the Chief Actuary of the Centers 
for Medicare & Medicaid Services in September 
of the previous year) to be enrolled under part 
B of title XVIII for months in the year divided 
by the average number of such individuals (as 
so estimated) under this subparagraph with re-
spect to enrollments in months in the previous 
year.’’. 
SEC. 212. PERMANENT EXTENSION OF TRANSITIONAL MED-
ICAL ASSISTANCE (TMA). 
(a) IN GENERAL.—Section 1925 of the Social Secu-
rity Act (42 U.S.C. 1396r–6) is amended— 
(1) by striking subsection (f); and 
(2) by redesignating subsection (g) as sub-
section (f). 
(b) CONFORMING AMENDMENT.—Section 1902(e)(1) 
of the Social Security Act (42 U.S.C. 1396a(e)(1)) is 
amended to read as follows: 
‘‘(1) Beginning April 1, 1990, for provisions relating 
to the extension of eligibility for medical assistance for cer-
tain families who have received aid pursuant to a State
186 
plan approved under part A of title IV and have earned 
income, see section 1925.’’. 
SEC. 213. EXTENSION OF SPECIAL DIABETES PROGRAM 
FOR TYPE I DIABETES AND FOR INDIANS. 
(a) SPECIAL DIABETES PROGRAMS FOR TYPE I DIA-
BETES.—Section 330B(b)(2)(C) of the Public Health 
Service Act (42 U.S.C. 254c–2(b)(2)(C)) is amended by 
striking ‘‘2015’’ and inserting ‘‘2017’’. 
(b) SPECIAL DIABETES PROGRAMS FOR INDIANS.— 
Section 330C(c)(2)(C) of the Public Health Service Act 
(42 U.S.C. 254c–3(c)(2)(C)) is amended by striking 
‘‘2015’’ and inserting ‘‘2017’’. 
SEC. 214. EXTENSION OF ABSTINENCE EDUCATION. 
(a) IN GENERAL.—Section 510 of the Social Security 
Act (42 U.S.C. 710) is amended— 
(1) in subsection (a), striking ‘‘2015’’ and in-
serting ‘‘2017’’; and 
(2) in subsection (d), by inserting ‘‘and an ad-
ditional $75,000,000 for each of fiscal years 2016 
and 2017’’ after ‘‘2015’’. 
(b) BUDGET
SCORING.—Notwithstanding section 
257(b)(2) of the Balanced Budget and Emergency Deficit 
Control Act of 1985, the baseline shall be calculated as-
suming that no grant shall be made under section 510
187 
of the Social Security Act (42 U.S.C. 710) after fiscal year 
2017. 
(c) REALLOCATION OF UNUSED FUNDING.—The re-
maining unobligated balances of the amount appropriated 
for fiscal years 2016 and 2017 by section 510(d) of the 
Social Security Act (42 U.S.C. 710(d)) for which no appli-
cation has been received by the Funding Opportunity An-
nouncement deadline, shall be made available to States 
that require the implementation of each element described 
in subparagraphs (A) through (H) of the definition of ab-
stinence education in section 510(b)(2). The remaining 
unobligated balances shall be reallocated to such States 
that submit a valid application consistent with the original 
formula for this funding. 
SEC. 215. EXTENSION OF PERSONAL RESPONSIBILITY EDU-
CATION PROGRAM (PREP). 
Section 513 of the Social Security Act (42 U.S.C. 
713) is amended— 
(1) in paragraphs (1)(A) and (4)(A) of sub-
section (a), by striking ‘‘2015’’ and inserting 
‘‘2017’’ each place it appears; 
(2) in subsection (a)(4)(B)(i), by striking ‘‘, 
2013, 2014, and 2015’’ and inserting ‘‘through 
2017’’; and
188 
(3) in subsection (f), by striking ‘‘2015’’ and 
inserting ‘‘2017’’. 
SEC. 216. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY 
HEALTH INFORMATION CENTERS. 
Section 501(c)(1)(A) of the Social Security Act (42 
U.S.C. 701(c)(1)(A)) is amended— 
(1) by striking clause (vi); and 
(2) by adding after clause (v) the following new 
clause: 
‘‘(vi) $5,000,000 for each of fiscal years 2015 
through 2017.’’. 
SEC. 217. EXTENSION OF HEALTH WORKFORCE DEM-
ONSTRATION PROJECT FOR LOW-INCOME IN-
DIVIDUALS. 
Section 2008(c)(1) of the Social Security Act (42 
U.S.C. 1397g(c)(1)) is amended by striking ‘‘2015’’ and 
inserting ‘‘2017’’. 
SEC. 218. EXTENSION OF MATERNAL, INFANT, AND EARLY 
CHILDHOOD HOME VISITING PROGRAMS. 
Section 511(j)(1) of the Social Security Act (42 
U.S.C. 711(j)) is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (E); 
(2) in subparagraph (F)—
189 
(A) by striking ‘‘for the period beginning 
on October 1, 2014, and ending on March 31, 
2015’’ and inserting ‘‘for fiscal year 2015’’; 
(B) by striking ‘‘an amount equal to the 
amount provided in subparagraph (E)’’ and in-
serting ‘‘$400,000,000’’; and 
(C) by striking the period at the end and 
inserting a semicolon; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(G) for fiscal year 2016, $400,000,000; 
and 
‘‘(H) for fiscal year 2017, $400,000,000.’’. 
SEC. 219. TENNESSEE DSH ALLOTMENT FOR FISCAL YEARS 
2015 THROUGH 2025. 
Section 1923(f)(6)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)(A)) is amended by adding at the end 
the following: 
‘‘(vi) ALLOTMENT FOR FISCAL YEARS 
2015 THROUGH 2025.—Notwithstanding any 
other provision of this subsection, any 
other provision of law, or the terms of the 
TennCare Demonstration Project in effect 
for the State, the DSH allotment for Ten-
nessee for fiscal year 2015, and for each
190 
fiscal year thereafter through fiscal year 
2025, shall be $53,100,000 for each such 
fiscal year.’’. 
SEC. 220. DELAY IN EFFECTIVE DATE FOR MEDICAID 
AMENDMENTS RELATING TO BENEFICIARY 
LIABILITY SETTLEMENTS. 
Section 202(c) of the Bipartisan Budget Act of 2013 
(division A of Public Law 113–67; 42 U.S.C. 1396a note), 
as amended by section 211 of the Protecting Access to 
Medicare Act of 2014 (Public Law 113–93; 128 Stat. 
1047) is amended by striking ‘‘October 1, 2016’’ and in-
serting ‘‘October 1, 2017’’. 
SEC. 221. EXTENSION OF FUNDING FOR COMMUNITY 
HEALTH CENTERS, THE NATIONAL HEALTH 
SERVICE CORPS, AND TEACHING HEALTH 
CENTERS. 
(a) FUNDING FOR COMMUNITY HEALTH CENTERS 
AND THE NATIONAL HEALTH SERVICE CORPS.— 
(1) COMMUNITY
HEALTH
CENTERS.—Section 
10503(b)(1)(E) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 254b–2(b)(1)(E)) is 
amended by striking ‘‘for fiscal year 2015’’ and in-
serting ‘‘for each of fiscal years 2015 through 
2017’’.
191 
(2) NATIONAL HEALTH SERVICE CORPS.—Sec-
tion 10503(b)(2)(E) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 254b–2(b)(2)(E)) is 
amended by striking ‘‘for fiscal year 2015’’ and in-
serting ‘‘for each of fiscal years 2015 through 
2017’’. 
(b) EXTENSION OF TEACHING HEALTH CENTERS 
PROGRAM.—Section 340H(g) of the Public Health Service 
Act (42 U.S.C. 256h(g)) is amended by inserting ‘‘and 
$60,000,000 for each of fiscal years 2016 and 2017’’ be-
fore the period at the end. 
(c) APPLICATION.—Amounts appropriated pursuant 
to this section for fiscal year 2016 and fiscal year 2017 
are subject to the requirements contained in Public Law 
113–235 for funds for programs authorized under sections 
330 through 340 of the Public Health Service Act (42 
U.S.C. 254b–256). 
TITLE III—CHIP 
SEC. 301. 2-YEAR EXTENSION OF THE CHILDREN’S HEALTH 
INSURANCE PROGRAM. 
(a) FUNDING.—Section 2104(a) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)) is amended— 
(1) in paragraph (17), by striking ‘‘and’’ at the 
end;
192 
(2) in paragraph (18)(B), by striking the period 
at the end and inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(19) for fiscal year 2016, $19,300,000,000; 
and 
‘‘(20) for fiscal year 2017, for purposes of mak-
ing 2 semi-annual allotments— 
‘‘(A) $2,850,000,000 for the period begin-
ning on October 1, 2016, and ending on March 
31, 2017; and 
‘‘(B) $2,850,000,000 for the period begin-
ning on April 1, 2017, and ending on Sep-
tember 30, 2017.’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the So-
cial Security Act (42 U.S.C. 1397dd(m)) is amend-
ed— 
(A) in the subsection heading, by striking 
‘‘THROUGH 2015’’ and inserting ‘‘AND THERE-
AFTER’’; 
(B) in paragraph (2)— 
(i) in the paragraph heading, by strik-
ing ‘‘2014’’ and inserting ‘‘2016’’; and
193 
(ii) by striking subparagraph (B) and 
inserting the following new subparagraph: 
‘‘(B) FISCAL YEAR 2013 AND EACH SUC-
CEEDING FISCAL YEAR.—Subject to paragraphs 
(5) and (7), from the amount made available 
under paragraphs (16) through (19) of sub-
section (a) for fiscal year 2013 and each suc-
ceeding fiscal year, respectively, the Secretary 
shall compute a State allotment for each State 
(including the District of Columbia and each 
commonwealth and territory) for each such fis-
cal year as follows: 
‘‘(i) REBASING IN FISCAL YEAR 2013 
AND
EACH
SUCCEEDING
ODD-NUMBERED 
FISCAL YEAR.—For fiscal year 2013 and 
each succeeding odd-numbered fiscal year 
(other than fiscal years 2015 and 2017), 
the allotment of the State is equal to the 
Federal payments to the State that are at-
tributable to (and countable toward) the 
total amount of allotments available under 
this section to the State in the preceding 
fiscal year (including payments made to 
the State under subsection (n) for such 
preceding fiscal year as well as amounts
194 
redistributed to the State in such pre-
ceding fiscal year), multiplied by the allot-
ment increase factor under paragraph (6) 
for such odd-numbered fiscal year. 
‘‘(ii) GROWTH FACTOR UPDATE FOR 
FISCAL YEAR 2014 AND EACH SUCCEEDING 
EVEN-NUMBERED
FISCAL
YEAR.—Except 
as provided in clauses (iii) and (iv), for fis-
cal year 2014 and each succeeding even- 
numbered fiscal year, the allotment of the 
State is equal to the sum of— 
‘‘(I) the amount of the State al-
lotment under clause (i) for the pre-
ceding fiscal year; and 
‘‘(II) the amount of any pay-
ments made to the State under sub-
section (n) for such preceding fiscal 
year, 
multiplied by the allotment increase factor 
under paragraph (6) for such even-num-
bered fiscal year. 
‘‘(iii) SPECIAL RULE FOR 2016.—For 
fiscal year 2016, the allotment of the State 
is equal to the Federal payments to the 
State that are attributable to (and count-
195 
able toward) the total amount of allot-
ments available under this section to the 
State in the preceding fiscal year (includ-
ing payments made to the State under 
subsection (n) for such preceding fiscal 
year as well as amounts redistributed to 
the State in such preceding fiscal year), 
but determined as if the last two sentences 
of section 2105(b) were in effect in such 
preceding fiscal year and then multiplying 
the result by the allotment increase factor 
under paragraph (6) for fiscal year 2016. 
‘‘(iv) REDUCTION IN 2018.—For fiscal 
year 2018, with respect to the allotment of 
the State for fiscal year 2017, any 
amounts of such allotment that remain 
available for expenditure by the State in 
fiscal year 2018 shall be reduced by one- 
third.’’; 
(C) in paragraph (4), by inserting ‘‘or 
2017’’ after ‘‘2015’’; 
(D) in paragraph (6)— 
(i) in subparagraph (A), by striking 
‘‘2015’’ and inserting ‘‘2017’’; and
196 
(ii) in the second sentence, by striking 
‘‘or fiscal year 2014’’ and inserting ‘‘fiscal 
year 2014, or fiscal year 2016’’; 
(E) in paragraph (8)— 
(i) in the paragraph heading, by strik-
ing ‘‘FISCAL
YEAR
2015’’ and inserting 
‘‘FISCAL YEARS 2015 AND 2017’’; and 
(ii) by inserting ‘‘or fiscal year 2017’’ 
after ‘‘2015’’; 
(F) 
by 
redesignating 
paragraphs 
(4) 
through (8) as paragraphs (5) through (9), re-
spectively; and 
(G) by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) FOR FISCAL YEAR 2017.— 
‘‘(A) FIRST HALF.—Subject to paragraphs 
(5) and (7), from the amount made available 
under subparagraph (A) of paragraph (20) of 
subsection (a) for the semi-annual period de-
scribed in such paragraph, increased by the 
amount of the appropriation for such period 
under section 301(b)(3) of the Medicare Access 
and CHIP Reauthorization Act of 2015, the 
Secretary shall compute a State allotment for 
each State (including the District of Columbia
197 
and each commonwealth and territory) for such 
semi-annual period in an amount equal to the 
first half ratio (described in subparagraph (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 
(20) of subsection (a) for the semi-annual pe-
riod described in such paragraph, 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
198 
amount of allotments available under this sec-
tion to the State in fiscal year 2016 (including 
payments made to the State under subsection 
(n) for fiscal year 2016 as well as amounts re-
distributed to the State in fiscal year 2016), 
multiplied by the allotment increase factor 
under paragraph (6) for fiscal year 2017. 
‘‘(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)(20)(A); and 
‘‘(II) the amount of the appro-
priation for such period under section 
301(b)(3) of the Medicare Access and 
CHIP Reauthorization Act of 2015; 
to 
‘‘(ii) the sum of the— 
‘‘(I) amount described in clause 
(i); and 
‘‘(II) the amount made available 
under subsection (a)(20)(B).’’. 
(2) CONFORMING AMENDMENTS.—
199 
(A) Section 2104(c)(1) of the Social Secu-
rity Act (42 U.S.C. 1397dd(c)(1)) is amended 
by striking ‘‘(m)(4)’’ and inserting ‘‘(m)(5)’’. 
(B) Section 2104(m) of such Act (42 
U.S.C. 1397dd(m)), as amended by paragraph 
(1), is further amended— 
(i) in paragraph (1)— 
(I) by striking ‘‘paragraph (4)’’ 
each place it appears in subpara-
graphs (A) and (B) and inserting 
‘‘paragraph (5)’’; and 
(II) by striking ‘‘the allotment 
increase 
factor 
determined 
under 
paragraph (5)’’ each place it appears 
and inserting ‘‘the allotment increase 
factor determined under paragraph 
(6)’’; 
(ii) in paragraph (2)(A), by striking 
‘‘the allotment increase factor under para-
graph (5)’’ and inserting ‘‘the allotment in-
crease factor under paragraph (6)’’; 
(iii) in paragraph (3)— 
(I) by striking ‘‘paragraphs (4) 
and (6)’’ and inserting ‘‘paragraphs
200 
(5) and (7)’’ each place it appears; 
and 
(II) by striking ‘‘the allotment 
increase factor under paragraph (5)’’ 
and inserting ‘‘the allotment increase 
factor under paragraph (6)’’; 
(iv) in paragraph (5) (as redesignated 
by paragraph (1)(F)), by striking ‘‘para-
graph (1), (2), or (3)’’ and inserting 
‘‘paragraph (1), (2), (3), or (4)’’; 
(v) in paragraph (7) (as redesignated 
by paragraph (1)(F)), by striking ‘‘subject 
to paragraph (4)’’ and inserting ‘‘subject 
to paragraph (5)’’; and 
(vi) in paragraph (9), (as redesignated 
by paragraph (1)(F)), by striking ‘‘para-
graph (3)’’ and inserting ‘‘paragraph (3) 
or (4)’’. 
(C) Section 2104(n)(3)(B)(ii) of such Act 
(42 U.S.C. 1397dd(n)(3)(B)(ii)) is amended by 
striking ‘‘subsection (m)(5)(B)’’ and inserting 
‘‘subsection (m)(6)(B)’’. 
(D) Section 2111(b)(2)(B)(i) of such Act 
(42 U.S.C. 1397kk(b)(2)(B)(i)) is amended by
201 
striking ‘‘section 2104(m)(4)’’ and inserting 
‘‘section 2104(m)(5)’’. 
(3) ONE-TIME
APPROPRIATION
FOR
FISCAL 
YEAR 2017.—There is appropriated to the Secretary 
of Health and Human Services, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated, 
$14,700,000,000 to accompany the allotment made 
for the period beginning on October 1, 2016, and 
ending on March 31, 2017, under paragraph 
(20)(A) of section 2104(a) of the Social Security Act 
(42 U.S.C. 1397dd(a)) (as added by subsection 
(a)(1)), to remain available until expended. Such 
amount shall be used to provide allotments to States 
under paragraph (4) of section 2104(m) of such Act 
(42 U.S.C. 1397dd(m)) (as amended by para-
graph(1)(G)) for the first 6 months of fiscal year 
2017 in the same manner as allotments are provided 
under subsection (a)(20)(A) of such section 2104 
and subject to the same terms and conditions as 
apply to the allotments provided from such sub-
section (a)(20)(A). 
(c) EXTENSION OF QUALIFYING STATES OPTION.— 
Section 2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended—
202 
(1) in the paragraph heading, by striking 
‘‘2015’’ and inserting ‘‘2017’’; and 
(2) in subparagraph (A), by striking ‘‘2015’’ 
and inserting ‘‘2017’’. 
(d) EXTENSION OF THE CHILD ENROLLMENT CON-
TINGENCY FUND.— 
(1) IN GENERAL.—Section 2104(n) of the So-
cial Security Act (42 U.S.C. 1397dd(n)) is amend-
ed— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
(I) by striking ‘‘2010 through 
2014’’ and inserting ‘‘2010, 2011, 
2012, 2013, 2014, and 2016’’; and 
(II) by inserting ‘‘and fiscal year 
2017’’ after ‘‘2015’’; and 
(ii) in subparagraph (B)— 
(I) by striking ‘‘2010 through 
2014’’ and inserting ‘‘2010, 2011, 
2012, 2013, 2014, and 2016’’; and 
(II) by inserting ‘‘and fiscal year 
2017’’ after ‘‘2015’’; and 
(B) in paragraph (3)(A), in the matter 
preceding clause (i), by striking ‘‘fiscal year 
2009, fiscal year 2010, fiscal year 2011, fiscal
203 
year 2012, fiscal year 2013, fiscal year 2014, or 
a semi-annual allotment period for fiscal year 
2015’’ and inserting ‘‘any of fiscal years 2009 
through 2014, fiscal year 2016, or a semi-an-
nual allotment period for fiscal year 2015 or 
2017’’. 
SEC. 302. EXTENSION OF EXPRESS LANE ELIGIBILITY. 
Section 1902(e)(13)(I) of the Social Security Act (42 
U.S.C. 1396a(e)(13)(I)) is amended by striking ‘‘2015’’ 
and inserting ‘‘2017’’. 
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT 
PROGRAM. 
Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended— 
(1) in subsection (a)(1), by striking ‘‘2015’’ and 
inserting ‘‘2017’’; and 
(2) in subsection (g), by inserting ‘‘and 
$40,000,000 for the period of fiscal years 2016 and 
2017’’ after ‘‘2015’’. 
SEC. 304. EXTENSION OF CERTAIN PROGRAMS AND DEM-
ONSTRATION PROJECTS. 
(a) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.—Section 1139A(e)(8) of the Social Security 
Act (42 U.S.C. 1320b–9a(e)(8)) is amended by inserting
204 
‘‘, and $10,000,000 for the period of fiscal years 2016 
and 2017’’ after ‘‘2014’’. 
(b) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i) of the Social Security Act (42 U.S.C. 
1320b–9a(i)) is amended in the first sentence by inserting 
before the period at the end the following: ‘‘, and there 
is appropriated for the period of fiscal years 2016 and 
2017, $20,000,000 for the purpose of carrying out this 
section (other than subsections (e), (f), and (g))’’. 
SEC. 305. REPORT OF INSPECTOR GENERAL OF HHS ON 
USE OF EXPRESS LANE OPTION UNDER MED-
ICAID AND CHIP. 
Not later than 18 months after the date of the enact-
ment of this Act, the Inspector General of the Department 
of Health and Human Services shall submit to the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate 
a report that— 
(1) provides data on the number of individuals 
enrolled in the Medicaid program under title XIX of 
the Social Security Act (referred to in this section 
as ‘‘Medicaid’’) and the Children’s Health Insurance 
Program under title XXI of such Act (referred to in 
this section as ‘‘CHIP’’) through the use of the Ex-
205 
press Lane option under section 1902(e)(13) of the 
Social Security Act (42 U.S.C. 1396a(e)(13)); 
(2) assesses the extent to which individuals so 
enrolled meet the eligibility requirements under Med-
icaid or CHIP (as applicable); and 
(3) provides data on Federal and State expendi-
tures under Medicaid and CHIP for individuals so 
enrolled and disaggregates such data between ex-
penditures made for individuals who meet the eligi-
bility requirements under Medicaid or CHIP (as ap-
plicable) and expenditures made for individuals who 
do not meet such requirements. 
TITLE IV—OFFSETS 
Subtitle A—Medicare Beneficiary 
Reforms 
SEC. 401. LIMITATION ON CERTAIN MEDIGAP POLICIES 
FOR 
NEWLY 
ELIGIBLE 
MEDICARE 
BENE-
FICIARIES. 
Section 1882 of the Social Security Act (42 U.S.C. 
1395ss) is amended by adding at the end the following 
new subsection: 
‘‘(z) LIMITATION ON CERTAIN MEDIGAP POLICIES 
FOR NEWLY ELIGIBLE MEDICARE BENEFICIARIES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this section, on or after January 1,
206 
2020, a medicare supplemental policy that provides 
coverage of the part B deductible, including any 
such policy (or rider to such a policy) issued under 
a waiver granted under subsection (p)(6), may not 
be sold or issued to a newly eligible Medicare bene-
ficiary. 
‘‘(2) NEWLY ELIGIBLE MEDICARE BENEFICIARY 
DEFINED.—In this subsection, the term ‘newly eligi-
ble Medicare beneficiary’ means an individual who is 
neither of the following: 
‘‘(A) An individual who has attained age 
65 before January 1, 2020. 
‘‘(B) An individual who was entitled to 
benefits under part A pursuant to section 
226(b) or 226A, or deemed to be eligible for 
benefits under section 226(a), before January 
1, 2020. 
‘‘(3) TREATMENT OF WAIVERED STATES.—In 
the case of a State described in subsection (p)(6), 
nothing in this section shall be construed as pre-
venting the State from modifying its alternative sim-
plification program under such subsection so as to 
eliminate the coverage of the part B deductible for 
any medical supplemental policy sold or issued under
207 
such program to a newly eligible Medicare bene-
ficiary on or after January 1, 2020. 
‘‘(4) TREATMENT OF REFERENCES TO CERTAIN 
POLICIES.—In the case of a newly eligible Medicare 
beneficiary, except as the Secretary may otherwise 
provide, any reference in this section to a medicare 
supplemental policy which has a benefit package 
classified as ‘C’ or ‘F’ shall be deemed, as of Janu-
ary 1, 2020, to be a reference to a medicare supple-
mental policy which has a benefit package classified 
as ‘D’ or ‘G’, respectively. 
‘‘(5) ENFORCEMENT.—The penalties described 
in clause (ii) of subsection (d)(3)(A) shall apply with 
respect to a violation of paragraph (1) in the same 
manner as it applies to a violation of clause (i) of 
such subsection.’’. 
SEC. 402. INCOME-RELATED PREMIUM ADJUSTMENT FOR 
PARTS B AND D. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i) of the 
Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)) is 
amended— 
(1) by inserting after ‘‘IN GENERAL.—’’ the fol-
lowing: 
‘‘(I) Subject to paragraphs (5) 
and (6), for years before 2018:’’; and
208 
(2) by adding at the end the following: 
‘‘(II) Subject to paragraph (5), 
for years beginning with 2018: 
‘‘If the modified adjusted gross income is: 
The applicable 
percentage is:
More than $85,000 but not more than $107,000 ......
35 percent
More than $107,000 but not more than $133,500 ....
50 percent
More than $133,500 but not more than $160,000 ....
65 percent
More than $160,000 ...................................................
80 percent.’’. 
(b) CONFORMING AMENDMENTS.—Section 1839(i) of 
the Social Security Act (42 U.S.C. 1395r(i)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘(or, be-
ginning with 2018, $85,000)’’ after ‘‘$80,000’’; 
(2) in paragraph (3)(A)(i), by inserting ‘‘appli-
cable’’ before ‘‘table’’; 
(3) in paragraph (5)(A)— 
(A) in the matter before clause (i), by in-
serting ‘‘(other than 2018 and 2019)’’ after 
‘‘2007’’; and 
(B) in clause (ii), by inserting ‘‘(or, in the 
case of a calendar year beginning with 2020, 
August 2018)’’ after ‘‘August 2006’’; and 
(4) in paragraph (6), in the matter before sub-
paragraph (A), by striking ‘‘2019’’ and inserting 
‘‘2017’’.
209 
Subtitle B—Other Offsets 
SEC. 411. MEDICARE PAYMENT UPDATES FOR POST-ACUTE 
PROVIDERS. 
(a) SNFS.—Section 1888(e) of the Social Security 
Act (42 U.S.C. 1395yy(e))— 
(1) in paragraph (5)(B)— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clauses (ii) and (iii)’’; 
(B) in clause (ii), by inserting ‘‘subject to 
clause (iii),’’ after ‘‘each subsequent fiscal 
year,’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
FISCAL 
YEAR 2018.—For fiscal year 2018 (or other 
similar annual period specified in clause 
(i)), the skilled nursing facility market bas-
ket percentage, after application of clause 
(ii), is equal to 1 percent.’’; and 
(2) in paragraph (6)(A), by striking ‘‘paragraph 
(5)(B)(ii)’’ and inserting ‘‘clauses (ii) and (iii) of 
paragraph (5)(B)’’ each place it appears. 
(b) IRFS.—Section 1886(j) of the Social Security Act 
(42 U.S.C. 1395ww(j)) is amended— 
(1) in paragraph (3)(C)—
210 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘clauses (ii) and (iii)’’; 
(B) in clause (ii), by striking ‘‘After’’ and 
inserting ‘‘Subject to clause (iii), after’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(iii) SPECIAL
RULE
FOR
FISCAL 
YEAR 2018.—The increase factor to be ap-
plied under this subparagraph for fiscal 
year 2018, after the application of clause 
(ii), shall be 1 percent.’’; and 
(2) in paragraph (7)(A)(i), by striking ‘‘para-
graph (3)(D)’’ and inserting ‘‘subparagraphs (C)(iii) 
and (D) of paragraph (3)’’. 
(c) HHAS.—Section 1895(b)(3)(B) of the Social Se-
curity Act (42 U.S.C. 1395fff(b)(3)(B)) is amended— 
(1) in clause (iii), by adding at the end the fol-
lowing: ‘‘Notwithstanding the previous sentence, the 
home health market basket percentage increase for 
2018 shall be 1 percent.’’; and 
(2) in clause (vi)(I), by inserting ‘‘(except 
2018)’’ after ‘‘each subsequent year’’. 
(d) HOSPICE.—Section 1814(i) of the Social Security 
Act (42 U.S.C. 1395f(i)) is amended— 
(1) in paragraph (1)(C)—
211 
(A) in clause (ii)(VII), by striking ‘‘clause 
(iv),,’’ and inserting ‘‘clauses (iv) and (vi),’’; 
(B) in clause (iii), by striking ‘‘clause 
(iv),’’ and inserting ‘‘clauses (iv) and (vi),’’; 
(C) in clause (iv), by striking ‘‘After deter-
mining’’ and inserting ‘‘Subject to clause (vi), 
after determining’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(vi) For fiscal year 2018, the market basket per-
centage increase under clause (ii)(VII) or (iii), as applica-
ble, after application of clause (iv), shall be 1 percent.’’; 
and 
(2) in paragraph (5)(A)(i), by striking ‘‘para-
graph (1)(C)(iv)’’ and inserting ‘‘clauses (iv) and 
(vi) of paragraph (1)(C)’’. 
(e) LTCHS.—Section 1886(m)(3) of the Social Secu-
rity Act (42 U.S.C. 1395ww(m)(3)) is amended— 
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘In implementing’’ and 
inserting ‘‘Subject to subparagraph (C), in imple-
menting’’; and 
(2) by adding at the end the following new sub-
paragraph:
212 
‘‘(C) ADDITIONAL
SPECIAL
RULE.—For 
fiscal year 2018, the annual update under sub-
paragraph (A) for the fiscal year, after applica-
tion of clauses (i) and (ii) of subparagraph (A), 
shall be 1 percent.’’. 
SEC. 412. DELAY OF REDUCTION TO MEDICAID DSH ALLOT-
MENTS. 
Section 1923(f) of the Social Security Act (42 U.S.C. 
1396r–4(f)) is amended— 
(1) in paragraph (7)(A)— 
(A) in clause (i), by striking ‘‘2017 
through 2024’’ and inserting ‘‘2018 through 
2025’’; 
(B) by striking clause (ii) and inserting the 
following new clause: 
‘‘(ii) AGGREGATE REDUCTIONS.—The 
aggregate reductions in DSH allotments 
for all States under clause (i)(I) shall be 
equal to— 
‘‘(I) $2,000,000,000 for fiscal 
year 2018; 
‘‘(II) $3,000,000,000 for fiscal 
year 2019; 
‘‘(III) $4,000,000,000 for fiscal 
year 2020;
213 
‘‘(IV) $5,000,000,000 for fiscal 
year 2021; 
‘‘(V) $6,000,000,000 for fiscal 
year 2022; 
‘‘(VI) $7,000,000,000 for fiscal 
year 2023; 
‘‘(VII) $8,000,000,000 for fiscal 
year 2024; and 
‘‘(VIII) $8,000,000,000 for fiscal 
year 2025.’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(v) DISTRIBUTION
OF
AGGREGATE 
REDUCTIONS.—The Secretary shall dis-
tribute the aggregate reductions under 
clause (ii) among States in accordance 
with subparagraph (B).’’; and 
(2) in paragraph (8), by striking ‘‘2024’’ and 
inserting ‘‘2025’’. 
SEC. 413. LEVY ON DELINQUENT PROVIDERS. 
(a) IN GENERAL.—Paragraph (3) of section 6331(h) 
of the Internal Revenue Code of 1986 is amended by strik-
ing ‘‘30 percent’’ and inserting ‘‘100 percent’’.
214 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to payments made after 180 days 
after the date of the enactment of this Act. 
SEC. 414. ADJUSTMENTS TO INPATIENT HOSPITAL PAY-
MENT RATES. 
Section 7(b) of the TMA, Abstinence Education, and 
QI Programs Extension Act of 2007 (Public Law 110– 
90), as amended by section 631(b) of the American Tax-
payer Relief Act of 2012 (Public Law 112–240), is amend-
ed— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘, 2009, or 2010’’ and insert-
ing ‘‘or 2009’’; and 
(B) in subparagraph (B)— 
(i) in clause (i), by striking ‘‘and’’ at 
the end; 
(ii) in clause (ii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iii) make an additional adjustment to the 
standardized 
amounts 
under 
such 
section 
1886(d) of an increase of 0.5 percentage points 
for discharges occurring during each of fiscal
215 
years 2018 through 2023 and not make the ad-
justment (estimated to be an increase of 3.2 
percent) that would otherwise apply for dis-
charges occurring during fiscal year 2018 by 
reason of the completion of the adjustments re-
quired under clause (ii).’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘shall be construed’’ and 
all that follows through ‘‘providing authority’’ 
and inserting ‘‘shall be construed as providing 
authority’’; and 
(B) by inserting ‘‘and each succeeding fis-
cal year through fiscal year 2023’’ after 
‘‘2017’’; 
(3) by redesignating paragraphs (3) and (4) as 
paragraphs (4) and (5), respectively; and 
(4) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3) PROHIBITION.—The Secretary shall not 
make an additional prospective adjustment (esti-
mated to be a decrease of 0.55 percent) to the 
standardized amounts under such section 1886(d) to 
offset the amount of the increase in aggregate pay-
ments related to documentation and coding changes 
for discharges occurring during fiscal year 2010.’’.
216 
TITLE V—MISCELLANEOUS 
Subtitle A—Protecting the 
Integrity of Medicare 
SEC. 501. PROHIBITION OF INCLUSION OF SOCIAL SECU-
RITY ACCOUNT NUMBERS ON MEDICARE 
CARDS. 
(a) IN GENERAL.—Section 205(c)(2)(C) of the Social 
Security Act (42 U.S.C. 405(c)(2)(C)) is amended— 
(1) by moving clause (x), as added by section 
1414(a)(2) of the Patient Protection and Affordable 
Care Act, 6 ems to the left; 
(2) by redesignating clause (x), as added by 
section 2(a)(1) of the Social Security Number Pro-
tection Act of 2010, and clause (xi) as clauses (xi) 
and (xii), respectively; and 
(3) by adding at the end the following new 
clause: 
‘‘(xiii) The Secretary of Health and Human Services, 
in consultation with the Commissioner of Social Security, 
shall establish cost-effective procedures to ensure that a 
Social Security account number (or derivative thereof) is 
not displayed, coded, or embedded on the Medicare card 
issued to an individual who is entitled to benefits under 
part A of title XVIII or enrolled under part B of title 
XVIII and that any other identifier displayed on such card
217 
is not identifiable as a Social Security account number (or 
derivative thereof).’’. 
(b) IMPLEMENTATION.—In implementing clause (xiii) 
of section 205(c)(2)(C) of the Social Security Act (42 
U.S.C. 405(c)(2)(C)), as added by subsection (a)(3), the 
Secretary of Health and Human Services shall do the fol-
lowing: 
(1) IN
GENERAL.—Establish a cost-effective 
process that involves the least amount of disruption 
to, as well as necessary assistance for, Medicare 
beneficiaries and health care providers, such as a 
process that provides such beneficiaries with access 
to assistance through a toll-free telephone number 
and provides outreach to providers. 
(2) CONSIDERATION
OF
MEDICARE
BENE-
FICIARY
IDENTIFIED.—Consider implementing a 
process, similar to the process involving Railroad Re-
tirement Board beneficiaries, under which a Medi-
care beneficiary identifier which is not a Social Secu-
rity account number (or derivative thereof) is used 
external to the Department of Health and Human 
Services and is convertible over to a Social Security 
account number (or derivative thereof) for use inter-
nal to such Department and the Social Security Ad-
ministration.
220 
SEC. 502. PREVENTING WRONGFUL MEDICARE PAYMENTS 
FOR ITEMS AND SERVICES FURNISHED TO IN-
CARCERATED 
INDIVIDUALS, 
INDIVIDUALS 
NOT LAWFULLY PRESENT, AND DECEASED IN-
DIVIDUALS. 
(a) REQUIREMENT FOR THE SECRETARY TO ESTAB-
LISH POLICIES AND CLAIMS EDITS RELATING TO INCAR-
CERATED INDIVIDUALS, INDIVIDUALS NOT LAWFULLY 
PRESENT, AND DECEASED INDIVIDUALS.—Section 1874 
of the Social Security Act (42 U.S.C. 1395kk) is amended 
by adding at the end the following new subsection: 
‘‘(f) REQUIREMENT FOR THE SECRETARY TO ESTAB-
LISH POLICIES AND CLAIMS EDITS RELATING TO INCAR-
CERATED INDIVIDUALS, INDIVIDUALS NOT LAWFULLY 
PRESENT, AND DECEASED INDIVIDUALS.—The Secretary 
shall establish and maintain procedures, including proce-
dures for using claims processing edits, updating eligibility 
information to improve provider accessibility, and con-
ducting recoupment activities such as through recovery 
audit contractors, in order to ensure that payment is not 
made under this title for items and services furnished to 
an individual who is one of the following: 
‘‘(1) An individual who is incarcerated. 
‘‘(2) An individual who is not lawfully present 
in the United States and who is not eligible for cov-
erage under this title.
221 
‘‘(3) A deceased individual.’’. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this section, and periodically 
thereafter as determined necessary by the Office of Inspec-
tor General of the Department of Health and Human 
Services, such Office shall submit to Congress a report 
on the activities described in subsection (f) of section 1874 
of the Social Security Act (42 U.S.C. 1395kk), as added 
by subsection (a), that have been conducted since such 
date of enactment. 
SEC. 503. CONSIDERATION OF MEASURES REGARDING 
MEDICARE BENEFICIARY SMART CARDS. 
To the extent the Secretary of Health and Human 
Services determines that it is cost effective and techno-
logically viable to use electronic Medicare beneficiary and 
provider cards (such as cards that use smart card tech-
nology, including an embedded and secure integrated cir-
cuit chip), as presented in the Government Accountability 
Office report required by the conference report accom-
panying the Consolidated Appropriations Act, 2014 (Pub-
lic Law 113–76), the Secretary shall consider such meas-
ures as determined appropriate by the Secretary to imple-
ment such use of such cards for beneficiary and provider 
use under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). In the case that the Secretary con-
222 
siders measures under the preceding sentence, the Sec-
retary shall submit to the Committees on Ways and Means 
and Energy and Commerce of the House of Representa-
tives, and to the Committee on Finance of the Senate, a 
report outlining the considerations undertaken by the Sec-
retary under such sentence. 
SEC. 
504. 
MODIFYING 
MEDICARE 
DURABLE 
MEDICAL 
EQUIPMENT 
FACE-TO-FACE 
ENCOUNTER 
DOCUMENTATION REQUIREMENT. 
(a) IN GENERAL.—Section 1834(a)(11)(B)(ii) of the 
Social Security Act (42 U.S.C. 1395m(a)(11)(B)(ii)) is 
amended— 
(1) by striking ‘‘the physician documenting 
that’’; and 
(2) by striking ‘‘has had a face-to-face encoun-
ter’’ and inserting ‘‘documenting such physician, 
physician assistant, practitioner, or specialist has 
had a face-to-face encounter’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by sub-
section (a) by program instruction or otherwise. 
SEC. 505. REDUCING IMPROPER MEDICARE PAYMENTS. 
(a) MEDICARE ADMINISTRATIVE CONTRACTOR IM-
PROPER PAYMENT OUTREACH
AND EDUCATION PRO-
223 
GRAM.—Section 1874A of the Social Security Act (42 
U.S.C. 1395kk–1) is amended— 
(1) in subsection (a)(4)— 
(A) by redesignating subparagraph (G) as 
subparagraph (H); and 
(B) by inserting after subparagraph (F) 
the following new subparagraph: 
‘‘(G) IMPROPER PAYMENT OUTREACH AND 
EDUCATION PROGRAM.—Having in place an im-
proper payment outreach and education pro-
gram described in subsection (h).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) IMPROPER PAYMENT OUTREACH
AND EDU-
CATION PROGRAM.— 
‘‘(1) IN
GENERAL.—In order to reduce im-
proper payments under this title, each medicare ad-
ministrative contractor shall establish and have in 
place an improper payment outreach and education 
program under which the contractor, through out-
reach, education, training, and technical assistance 
or other activities, shall provide providers of services 
and suppliers located in the region covered by the 
contract under this section with the information de-
scribed in paragraph (2). The activities described in
224 
the preceding sentence shall be conducted on a reg-
ular basis. 
‘‘(2) INFORMATION TO BE PROVIDED THROUGH 
ACTIVITIES.—The information to be provided under 
such payment outreach and education program shall 
include information the Secretary determines to be 
appropriate, which may include the following infor-
mation: 
‘‘(A) A list of the providers’ or suppliers’ 
most frequent and expensive payment errors 
over the last quarter. 
‘‘(B) Specific instructions regarding how to 
correct or avoid such errors in the future. 
‘‘(C) A notice of new topics that have been 
approved by the Secretary for audits conducted 
by recovery audit contractors under section 
1893(h). 
‘‘(D) Specific instructions to prevent fu-
ture issues related to such new audits. 
‘‘(E) Other information determined appro-
priate by the Secretary. 
‘‘(3) PRIORITY.—A medicare administrative 
contractor shall give priority to activities under such 
program that will reduce improper payments that 
are one or more of the following:
225 
‘‘(A) Are for items and services that have 
the highest rate of improper payment. 
‘‘(B) Are for items and service that have 
the greatest total dollar amount of improper 
payments. 
‘‘(C) Are due to clear misapplication or 
misinterpretation of Medicare policies. 
‘‘(D) Are clearly due to common and inad-
vertent clerical or administrative errors. 
‘‘(E) Are due to other types of errors that 
the Secretary determines could be prevented 
through activities under the program. 
‘‘(4) INFORMATION
ON
IMPROPER
PAYMENTS 
FROM RECOVERY AUDIT CONTRACTORS.— 
‘‘(A) IN
GENERAL.—In order to assist 
medicare administrative contractors in carrying 
out improper payment outreach and education 
programs, the Secretary shall provide each con-
tractor with a complete list of the types of im-
proper payments identified by recovery audit 
contractors under section 1893(h) with respect 
to providers of services and suppliers located in 
the region covered by the contract under this 
section. Such information shall be provided on
226 
a time frame the Secretary determines appro-
priate which may be on a quarterly basis. 
‘‘(B) INFORMATION.—The information de-
scribed in subparagraph (A) shall include infor-
mation such as the following: 
‘‘(i) Providers of services and sup-
pliers that have the highest rate of im-
proper payments. 
‘‘(ii) Providers of services and sup-
pliers that have the greatest total dollar 
amounts of improper payments. 
‘‘(iii) Items and services furnished in 
the region that have the highest rates of 
improper payments. 
‘‘(iv) Items and services furnished in 
the region that are responsible for the 
greatest total dollar amount of improper 
payments. 
‘‘(v) Other information the Secretary 
determines would assist the contractor in 
carrying out the program. 
‘‘(5) COMMUNICATIONS.—Communications with 
providers of services and suppliers under an im-
proper payment outreach and education program are
227 
subject to the standards and requirements of sub-
section (g).’’. 
(b) USE
OF
CERTAIN
FUNDS
RECOVERED
BY 
RACS.—Section 1893(h) of the Social Security Act (42 
U.S.C. 1395ddd(h)) is amended— 
(1) in paragraph (2), by inserting ‘‘or para-
graph (10)’’ after ‘‘paragraph (1)(C)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(10) USE OF CERTAIN RECOVERED FUNDS.— 
‘‘(A) IN
GENERAL.—After application of 
paragraph (1)(C), the Secretary shall retain a 
portion of the amounts recovered by recovery 
audit contractors for each year under this sec-
tion which shall be available to the program 
management account of the Centers for Medi-
care & Medicaid Services for purposes of, sub-
ject to subparagraph (B), carrying out sections 
1833(z), 1834(l)(16), and 1874A(a)(4)(G), car-
rying out section 514(b) of the Medicare Access 
and CHIP Reauthorization Act of 2015, and 
implementing strategies (such as claims proc-
essing edits) to help reduce the error rate of 
payments under this title. The amounts re-
tained under the preceding sentence shall not
228 
exceed an amount equal to 15 percent of the 
amounts recovered under this subsection, and 
shall remain available until expended. 
‘‘(B) LIMITATION.—Except for uses that 
support claims processing (including edits) or 
system 
functionality 
for 
detecting 
fraud, 
amounts retained under subparagraph (A) may 
not be used for technological-related infrastruc-
ture, capital investments, or information sys-
tems. 
‘‘(C) NO REDUCTION IN PAYMENTS TO RE-
COVERY
AUDIT
CONTRACTORS.—Nothing in 
subparagraph (A) shall reduce amounts avail-
able for payments to recovery audit contractors 
under this subsection.’’. 
SEC. 506. IMPROVING SENIOR MEDICARE PATROL AND 
FRAUD REPORTING REWARDS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall develop a plan to revise the incentive pro-
gram under section 203(b) of the Health Insurance Port-
ability and Accountability Act of 1996 (42 U.S.C. 1395b– 
5(b)) to encourage greater participation by individuals to 
report fraud and abuse in the Medicare program. Such 
plan shall include recommendations for—
229 
(1) ways to enhance rewards for individuals re-
porting under the incentive program, including re-
wards based on information that leads to an admin-
istrative action; and 
(2) extending the incentive program to the 
Medicaid program. 
(b) PUBLIC AWARENESS
AND EDUCATION CAM-
PAIGN.—The plan developed under subsection (a) shall 
also include recommendations for the use of the Senior 
Medicare Patrols authorized under section 411 of the 
Older Americans Act of 1965 (42 U.S.C. 3032) to conduct 
a public awareness and education campaign to encourage 
participation in the revised incentive program under sub-
section (a). 
(c) SUBMISSION OF PLAN.—Not later than 180 days 
after the date of enactment of this Act, the Secretary shall 
submit to Congress the plan developed under subsection 
(a). 
SEC. 507. REQUIRING VALID PRESCRIBER NATIONAL PRO-
VIDER IDENTIFIERS ON PHARMACY CLAIMS. 
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: 
‘‘(4) REQUIRING VALID PRESCRIBER NATIONAL 
PROVIDER IDENTIFIERS ON PHARMACY CLAIMS.—
230 
‘‘(A) IN GENERAL.—For plan year 2016 
and subsequent plan years, the Secretary shall 
require a claim for a covered part D drug for 
a part D eligible individual enrolled in a pre-
scription drug plan under this part or an MA– 
PD plan under part C to include a prescriber 
National Provider Identifier that is determined 
to be valid under the procedures established 
under subparagraph (B)(i). 
‘‘(B) PROCEDURES.— 
‘‘(i) VALIDITY
OF
PRESCRIBER
NA-
TIONAL
PROVIDER
IDENTIFIERS.—The 
Secretary, in consultation with appropriate 
stakeholders, shall establish procedures for 
determining the validity of prescriber Na-
tional Provider Identifiers under subpara-
graph (A). 
‘‘(ii) INFORMING
BENEFICIARIES
OF 
REASON FOR DENIAL.—The Secretary shall 
establish procedures to ensure that, in the 
case that a claim for a covered part D 
drug of an individual described in subpara-
graph (A) is denied because the claim does 
not meet the requirements of this para-
graph, the individual is properly informed
231 
at the point of service of the reason for the 
denial. 
‘‘(C) REPORT.—Not later than January 1, 
2018, the Inspector General of the Department 
of Health and Human Services shall submit to 
Congress a report on the effectiveness of the 
procedures established under subparagraph 
(B)(i).’’. 
SEC. 508. OPTION TO RECEIVE MEDICARE SUMMARY NO-
TICE ELECTRONICALLY. 
(a) IN GENERAL.—Section 1806 of the Social Secu-
rity Act (42 U.S.C. 1395b–7) is amended by adding at 
the end the following new subsection: 
‘‘(c) FORMAT OF STATEMENTS FROM SECRETARY.— 
‘‘(1) 
ELECTRONIC
OPTION
BEGINNING
IN 
2016.—Subject to paragraph (2), for statements de-
scribed in subsection (a) that are furnished for a pe-
riod in 2016 or a subsequent year, in the case that 
an individual described in subsection (a) elects, in 
accordance with such form, manner, and time speci-
fied by the Secretary, to receive such statement in 
an electronic format, such statement shall be fur-
nished to such individual for each period subsequent 
to such election in such a format and shall not be 
mailed to the individual.
232 
‘‘(2) LIMITATION ON REVOCATION OPTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary may determine a max-
imum number of elections described in para-
graph (1) by an individual that may be revoked 
by the individual. 
‘‘(B) MINIMUM OF ONE REVOCATION OP-
TION.—In no case may the Secretary determine 
a maximum number under subparagraph (A) 
that is less than one. 
‘‘(3) NOTIFICATION.—The Secretary shall en-
sure that, in the most cost effective manner and be-
ginning January 1, 2017, a clear notification of the 
option to elect to receive statements described in 
subsection (a) in an electronic format is made avail-
able, such as through the notices distributed under 
section 1804, to individuals described in subsection 
(a).’’. 
(b) ENCOURAGED
EXPANSION
OF
ELECTRONIC 
STATEMENTS.—To the extent to which the Secretary of 
Health and Human Services determines appropriate, the 
Secretary shall— 
(1) apply an option similar to the option de-
scribed in subsection (c)(1) of section 1806 of the 
Social Security Act (42 U.S.C. 1395b–7) (relating to
234 
this section, the Secretary shall make 
available to the public the performance of 
each medicare administrative contractor 
with respect to such performance require-
ments and measurement standards.’’. 
SEC. 510. STUDY ON PATHWAY FOR INCENTIVES TO STATES 
FOR STATE PARTICIPATION IN MEDICAID 
DATA MATCH PROGRAM. 
Section 1893(g) of the Social Security Act (42 U.S.C. 
1395ddd(g)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) INCENTIVES FOR STATES.—The Secretary 
shall study and, as appropriate, may specify incen-
tives for States to work with the Secretary for the 
purposes described in paragraph (1)(A)(ii). The ap-
plication of the previous sentence may include use of 
the waiver authority described in paragraph (2).’’. 
SEC. 511. GUIDANCE ON APPLICATION OF COMMON RULE 
TO CLINICAL DATA REGISTRIES. 
Not later than one year after the date of the enact-
ment of this section, the Secretary of Health and Human 
Services shall issue a clarification or modification with re-
spect to the application of subpart A of part 46 of title 
45, Code of Federal Regulations, governing the protection 
of human subjects in research (and commonly known as
235 
the ‘‘Common Rule’’), to activities, including quality im-
provement activities, involving clinical data registries, in-
cluding entities that are qualified clinical data registries 
pursuant to section 1848(m)(3)(E) of the Social Security 
Act (42 U.S.C. 1395w–4(m)(3)(E)). 
SEC. 512. ELIMINATING CERTAIN CIVIL MONEY PENALTIES; 
GAINSHARING STUDY AND REPORT. 
(a) ELIMINATING CIVIL MONEY PENALTIES FOR IN-
DUCEMENTS TO PHYSICIANS TO LIMIT SERVICES THAT 
ARE NOT MEDICALLY NECESSARY.— 
(1) IN GENERAL.—Section 1128A(b)(1) of the 
Social Security Act (42 U.S.C. 1320a–7a(b)(1)) is 
amended by inserting ‘‘medically necessary’’ after 
‘‘reduce or limit’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to payments made on 
or after the date of the enactment of this Act. 
(b) GAINSHARING STUDY AND REPORT.—Not later 
than 12 months after the date of the enactment of this 
Act, the Secretary of Health and Human Services, in con-
sultation with the Inspector General of the Department 
of Health and Human Services, shall submit to Congress 
a report with options for amending existing fraud and 
abuse laws in, and regulations related to, titles XI and 
XVIII of the Social Security Act (42 U.S.C. 301 et seq.),
236 
through exceptions, safe harbors, or other narrowly tar-
geted provisions, to permit gainsharing arrangements that 
otherwise would be subject to the civil money penalties de-
scribed in paragraphs (1) and (2) of section 1128A(b) of 
such Act (42 U.S.C. 1320a–7a(b)), or similar arrange-
ments between physicians and hospitals, and that improve 
care while reducing waste and increasing efficiency. The 
report shall— 
(1) consider whether such provisions should 
apply to ownership interests, compensation arrange-
ments, or other relationships; 
(2) describe how the recommendations address 
accountability, transparency, and quality, including 
how best to limit inducements to stint on care, dis-
charge patients prematurely, or otherwise reduce or 
limit medically necessary care; and 
(3) consider whether a portion of any savings 
generated by such arrangements (as compared to an 
historical benchmark or other metric specified by the 
Secretary to determine the impact of delivery and 
payment system changes under such title XVIII on 
expenditures made under such title) should accrue to 
the Medicare program under title XVIII of the So-
cial Security Act.
237 
SEC. 513. MODIFICATION OF MEDICARE HOME HEALTH 
SURETY BOND CONDITION OF PARTICIPA-
TION REQUIREMENT. 
Section 1861(o)(7) of the Social Security Act (42 
U.S.C. 1395x(o)(7)) is amended to read as follows: 
‘‘(7) provides the Secretary with a surety 
bond— 
‘‘(A) in a form specified by the Secretary 
and in an amount that is not less than the min-
imum of $50,000; and 
‘‘(B) that the Secretary determines is com-
mensurate with the volume of payments to the 
home health agency; and’’. 
SEC. 514. OVERSIGHT OF MEDICARE COVERAGE OF MAN-
UAL MANIPULATION OF THE SPINE TO COR-
RECT SUBLUXATION. 
(a) IN GENERAL.—Section 1833 of the Social Secu-
rity Act (42 U.S.C. 1395l) is amended by adding at the 
end the following new subsection: 
‘‘(z) MEDICAL REVIEW OF SPINAL SUBLUXATION 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall imple-
ment a process for the medical review (as described 
in paragraph (2)) of treatment by a chiropractor de-
scribed in section 1861(r)(5) by means of manual 
manipulation of the spine to correct a subluxation
238 
(as described in such section) of an individual who 
is enrolled under this part and apply such process to 
such services furnished on or after January 1, 2017, 
focusing on services such as— 
‘‘(A) services furnished by a such a chiro-
practor whose pattern of billing is aberrant 
compared to peers; and 
‘‘(B) services furnished by such a chiro-
practor who, in a prior period, has a services 
denial percentage in the 85th percentile or 
greater, taking into consideration the extent 
that service denials are overturned on appeal. 
‘‘(2) MEDICAL REVIEW.— 
‘‘(A) PRIOR AUTHORIZATION MEDICAL RE-
VIEW.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall use prior author-
ization medical review for services de-
scribed in paragraph (1) that are furnished 
to an individual by a chiropractor de-
scribed in section 1861(r)(5) that are part 
of an episode of treatment that includes 
more than 12 services. For purposes of the 
preceding sentence, an episode of treat-
ment shall be determined by the underlying
239 
cause that justifies the need for services, 
such as a diagnosis code. 
‘‘(ii) ENDING APPLICATION OF PRIOR 
AUTHORIZATION
MEDICAL
REVIEW.—The 
Secretary shall end the application of prior 
authorization medical review under clause 
(i) to services described in paragraph (1) 
by such a chiropractor if the Secretary de-
termines that the chiropractor has a low 
denial rate under such prior authorization 
medical review. The Secretary may subse-
quently reapply prior authorization medical 
review to such chiropractor if the Secretary 
determines it to be appropriate and the 
chiropractor has, in the time period subse-
quent to the determination by the Sec-
retary of a low denial rate with respect to 
the chiropractor, furnished such services 
described in paragraph (1). 
‘‘(iii) EARLY REQUEST FOR PRIOR AU-
THORIZATION REVIEW PERMITTED.—Noth-
ing in this subsection shall be construed to 
prevent such a chiropractor from request-
ing prior authorization for services de-
scribed in paragraph (1) that are to be
240 
furnished to an individual before the chiro-
practor furnishes the twelfth such service 
to such individual for an episode of treat-
ment. 
‘‘(B) TYPE
OF
REVIEW.—The Secretary 
may use pre-payment review or post-payment 
review 
of 
services 
described 
in 
section 
1861(r)(5) that are not subject to prior author-
ization medical review under subparagraph (A). 
‘‘(C) RELATIONSHIP
TO
LAW
ENFORCE-
MENT ACTIVITIES.—The Secretary may deter-
mine that medical review under this subsection 
does not apply in the case where potential fraud 
may be involved. 
‘‘(3) NO PAYMENT WITHOUT PRIOR AUTHORIZA-
TION.—With respect to a service described in para-
graph (1) for which prior authorization medical re-
view under this subsection applies, the following 
shall apply: 
‘‘(A) PRIOR AUTHORIZATION DETERMINA-
TION.—The Secretary shall make a determina-
tion, prior to the service being furnished, of 
whether the service would or would not meet 
the 
applicable 
requirements 
of 
section 
1862(a)(1)(A).
241 
‘‘(B) DENIAL
OF
PAYMENT.—Subject to 
paragraph (5), no payment may be made under 
this part for the service unless the Secretary 
determines pursuant to subparagraph (A) that 
the service would meet the applicable require-
ments of such section 1862(a)(1)(A). 
‘‘(4) SUBMISSION OF INFORMATION.—A chiro-
practor described in section 1861(r)(5) may submit 
the information necessary for medical review by fax, 
by mail, or by electronic means. The Secretary shall 
make available the electronic means described in the 
preceding sentence as soon as practicable. 
‘‘(5) TIMELINESS.—If the Secretary does not 
make a prior authorization determination under 
paragraph (3)(A) within 14 business days of the 
date of the receipt of medical documentation needed 
to make such determination, paragraph (3)(B) shall 
not apply. 
‘‘(6) APPLICATION OF LIMITATION ON BENE-
FICIARY
LIABILITY.—Where payment may not be 
made as a result of the application of paragraph 
(2)(B), section 1879 shall apply in the same manner 
as such section applies to a denial that is made by 
reason of section 1862(a)(1).
242 
‘‘(7) REVIEW BY CONTRACTORS.—The medical 
review described in paragraph (2) may be conducted 
by medicare administrative contractors pursuant to 
section 1874A(a)(4)(G) or by any other contractor 
determined appropriate by the Secretary that is not 
a recovery audit contractor. 
‘‘(8) MULTIPLE
SERVICES.—The Secretary 
shall, where practicable, apply the medical review 
under this subsection in a manner so as to allow an 
individual described in paragraph (1) to obtain, at a 
single time rather than on a service-by-service basis, 
an authorization in accordance with paragraph 
(3)(A) for multiple services. 
‘‘(9) CONSTRUCTION.—With respect to a serv-
ice described in paragraph (1) that has been af-
firmed by medical review under this subsection, 
nothing in this subsection shall be construed to pre-
clude the subsequent denial of a claim for such serv-
ice that does not meet other applicable requirements 
under this Act. 
‘‘(10) IMPLEMENTATION.— 
‘‘(A) AUTHORITY.—The Secretary may im-
plement the provisions of this subsection by in-
terim final rule with comment period.
243 
‘‘(B) ADMINISTRATION.—Chapter 35 of 
title 44, United States Code, shall not apply to 
medical review under this subsection.’’. 
(b) IMPROVING DOCUMENTATION OF SERVICES.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall, in consultation with stake-
holders (including the American Chiropractic Asso-
ciation) and representatives of medicare administra-
tive 
contractors 
(as 
defined 
in 
section 
1874A(a)(3)(A) of the Social Security Act (42 
U.S.C. 1395kk–1(a)(3)(A))), develop educational 
and training programs to improve the ability of 
chiropractors to provide documentation to the Sec-
retary of services described in section 1861(r)(5) in 
a manner that demonstrates that such services are, 
in accordance with section 1862(a)(1) of such Act 
(42 U.S.C. 1395y(a)(1)), reasonable and necessary 
for the diagnosis or treatment of illness or injury or 
to improve the functioning of a malformed body 
member. 
(2) TIMING.—The Secretary shall make the 
educational and training programs described in 
paragraph (1) publicly available not later than Janu-
ary 1, 2016.
244 
(3) FUNDING.—The Secretary shall use funds 
made available under paragraph (10) of section 
1893(h) of the Social Security Act (42 U.S.C. 
1395ddd(h)), as added by section 505, to carry out 
this subsection. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on the effective-
ness of the process for medical review of services 
furnished as part of a treatment by means of man-
ual manipulation of the spine to correct a sub-
luxation implemented under subsection (z) of section 
1833 of the Social Security Act (42 U.S.C. 1395l), 
as added by subsection (a). Such study shall include 
an analysis of— 
(A) aggregate data on— 
(i) the number of individuals, chiro-
practors, and claims for services subject to 
such review; and 
(ii) the number of reviews conducted 
under such section; and 
(B) the outcomes of such reviews. 
(2) REPORT.—Not later than four years after 
the date of enactment of this Act, the Comptroller 
General shall submit to Congress a report containing
245 
the results of the study conducted under paragraph 
(1), including recommendations for such legislation 
and administrative action with respect to the process 
for medical review implemented under subsection (z) 
of section 1833 of the Social Security Act (42 
U.S.C. 1395l) as the Comptroller General deter-
mines appropriate. 
SEC. 515. NATIONAL EXPANSION OF PRIOR AUTHORIZA-
TION MODEL FOR REPETITIVE SCHEDULED 
NON-EMERGENT AMBULANCE TRANSPORT. 
(a) INITIAL EXPANSION.— 
(1) IN GENERAL.—In implementing the model 
described in paragraph (2) proposed to be tested 
under subsection (b) of section 1115A of the Social 
Security Act (42 U.S.C. 1315a), the Secretary of 
Health and Human Services shall revise the testing 
under subsection (b) of such section to cover, effec-
tive not later than January 1, 2016, States located 
in medicare administrative contractor (MAC) regions 
L and 11 (consisting of Delaware, the District of 
Columbia, Maryland, New Jersey, Pennsylvania, 
North Carolina, South Carolina, West Virginia, and 
Virginia). 
(2) MODEL DESCRIBED.—The model described 
in this paragraph is the testing of a model of prior
246 
authorization for repetitive scheduled non-emergent 
ambulance transport proposed to be carried out in 
New Jersey, Pennsylvania, and South Carolina. 
(3) FUNDING.—The Secretary shall allocate 
funds made available under section 1115A(f)(1)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1315a(f)(1)(B)) to carry out this subsection. 
(b) NATIONAL EXPANSION.—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: 
‘‘(16) PRIOR AUTHORIZATION FOR REPETITIVE 
SCHEDULED
NON-EMERGENT
AMBULANCE
TRANS-
PORTS.— 
‘‘(A) IN GENERAL.—Beginning January 1, 
2017, if the expansion to all States of the 
model of prior authorization described in para-
graph (2) of section 515(a) of the Medicare Ac-
cess and CHIP Reauthorization Act of 2015 
meets the requirements described in paragraphs 
(1) through (3) of section 1115A(c), then the 
Secretary shall expand such model to all States. 
‘‘(B) FUNDING.—The Secretary shall use 
funds made available under section 1893(h)(10) 
to carry out this paragraph.
247 
‘‘(C) CLARIFICATION REGARDING BUDGET 
NEUTRALITY.—Nothing in this paragraph may 
be construed to limit or modify the application 
of section 1115A(b)(3)(B) to models described 
in such section, including with respect to the 
model described in subparagraph (A) and ex-
panded beginning on January 1, 2017, under 
such subparagraph.’’. 
SEC. 
516. 
REPEALING 
DUPLICATIVE 
MEDICARE 
SEC-
ONDARY PAYOR PROVISION. 
(a) IN GENERAL.—Section 1862(b)(5) of the Social 
Security Act (42 U.S.C. 1395y(b)(5)) is amended by in-
serting at the end the following new subparagraph: 
‘‘(E) END DATE.—The provisions of this 
paragraph shall not apply to information re-
quired to be provided on or after July 1, 
2016.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall apply to information required 
to be provided on or after January 1, 2016. 
SEC. 517. PLAN FOR EXPANDING DATA IN ANNUAL CERT 
REPORT. 
Not later than June 30, 2015, the Secretary of 
Health and Human Services shall submit to the Com-
248 
mittee on Finance of the Senate, and to the Committees 
on Energy and Commerce and Ways and Means of the 
House of Representatives— 
(1) a plan for including, in the annual report of 
the Comprehensive Error Rate Testing (CERT) pro-
gram, data on services (or groupings of services) 
(other than medical visits) paid under the physician 
fee schedule under section 1848 of the Social Secu-
rity Act (42 U.S.C. 1395w–4) where the fee sched-
ule amount is in excess of $250 and where the error 
rate is in excess of 20 percent; and 
(2) to the extent practicable by such date, spe-
cific examples of services described in paragraph (1). 
SEC. 518. REMOVING FUNDS FOR MEDICARE IMPROVE-
MENT FUND ADDED BY IMPACT ACT OF 2014. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)), as amended by section 3(e)(3) of 
the IMPACT Act of 2014 (Public Law 113–185), is 
amended by striking ‘‘$195,000,000’’ and inserting ‘‘$0’’. 
SEC. 519. RULE OF CONSTRUCTION. 
Except as explicitly provided in this subtitle, nothing 
in this subtitle, including the amendments made by this 
subtitle, shall be construed as preventing the use of notice 
and comment rulemaking in the implementation of the 
provisions of, and the amendments made by, this subtitle.
249 
Subtitle B—Other Provisions 
SEC. 521. EXTENSION OF TWO-MIDNIGHT PAMA RULES ON 
CERTAIN MEDICAL REVIEW ACTIVITIES. 
Section 111 of the Protecting Access to Medicare Act 
of 2014 (Public Law 113–93; 42 U.S.C. 1395ddd note) 
is amended— 
(1) in subsection (a), by striking ‘‘the first 6 
months of fiscal year 2015’’ and inserting ‘‘through 
the end of fiscal year 2015’’; 
(2) in subsection (b), by striking ‘‘March 31, 
2015’’ and inserting ‘‘September 30, 2015’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(c) CONSTRUCTION.—Except as provided in sub-
sections (a) and (b), nothing in this section shall be con-
strued as limiting the Secretary’s authority to pursue 
fraud and abuse activities under such section 1893(h) or 
otherwise.’’. 
SEC. 522. REQUIRING BID SURETY BONDS AND STATE LI-
CENSURE FOR ENTITIES SUBMITTING BIDS 
UNDER THE MEDICARE DMEPOS COMPETI-
TIVE ACQUISITION PROGRAM. 
(a) BID SURETY BONDS.—Section 1847(a)(1) of the 
Social Security Act (42 U.S.C. 1395w–3(a)(1)) is amend-
ed by adding at the end the following new subparagraphs:
250 
‘‘(G) REQUIRING BID BONDS FOR BIDDING 
ENTITIES.—With respect to rounds of competi-
tions beginning under this subsection for con-
tracts beginning not earlier than January 1, 
2017, and not later than January 1, 2019, an 
entity may not submit a bid for a competitive 
acquisition area unless, as of the deadline for 
bid submission, the entity has obtained (and 
provided the Secretary with proof of having ob-
tained) a bid surety bond (in this paragraph re-
ferred to as a ‘bid bond’) in a form specified by 
the Secretary consistent with subparagraph (H) 
and in an amount that is not less than $50,000 
and not more than $100,000 for each competi-
tive acquisition area in which the entity submits 
the bid. 
‘‘(H) TREATMENT
OF
BID
BONDS
SUB-
MITTED.— 
‘‘(i) FOR BIDDERS THAT SUBMIT BIDS 
AT OR BELOW THE MEDIAN AND ARE OF-
FERED
BUT
DO
NOT
ACCEPT
THE
CON-
TRACT.—In the case of a bidding entity 
that is offered a contract for any product 
category for a competitive acquisition area, 
if—
251 
‘‘(I) the entity’s composite bid 
for such product category and area 
was at or below the median composite 
bid rate for all bidding entities in-
cluded in the calculation of the single 
payment amounts for such product 
category and area; and 
‘‘(II) the entity does not accept 
the contract offered for such product 
category and area, 
the bid bond submitted by such entity for 
such area shall be forfeited by the entity 
and the Secretary shall collect on it. 
‘‘(ii) TREATMENT
OF
OTHER
BID-
DERS.—In the case of a bidding entity for 
any product category for a competitive ac-
quisition area, if the entity does not meet 
the bid forfeiture conditions in subclauses 
(I) and (II) of clause (i) for any product 
category for such area, the bid bond sub-
mitted by such entity for such area shall 
be returned within 90 days of the public 
announcement of the contract suppliers for 
such area.’’. 
(b) STATE LICENSURE.—
252 
(1) IN GENERAL.—Section 1847(b)(2)(A) of the 
Social Security Act (42 U.S.C. 1395w–3(b)(2)(A)) is 
amended by adding at the end the following new 
clause: 
‘‘(v) The entity meets applicable State 
licensure requirements.’’. 
(2) CONSTRUCTION.—Nothing in the amend-
ment made by paragraph (1) shall be construed as 
affecting the authority of the Secretary of Health 
and Human Services to require State licensure of an 
entity under the Medicare competitive acquisition 
program under section 1847 of the Social Security 
Act (42 U.S.C. 1395w–3) before the date of the en-
actment of this Act. 
(c) GAO REPORT ON BID BOND IMPACT ON SMALL 
SUPPLIERS.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study that evaluates 
the effect of the bid surety bond requirement under 
the amendment made by subsection (a) on the par-
ticipation of small suppliers in the Medicare 
DMEPOS competitive acquisition program under 
section 1847 of the Social Security Act (42 U.S.C. 
1395w–3).
253 
(2) REPORT.—Not later than 6 months after 
the date contracts are first awarded subject to such 
bid surety bond requirement, the Comptroller Gen-
eral shall submit to Congress a report on the study 
conducted under paragraph (1). Such report shall 
include recommendations for changes in such re-
quirement in order to ensure robust participation by 
legitimate small suppliers in the Medicare DMEPOS 
competition acquisition program. 
SEC. 523. PAYMENT FOR GLOBAL SURGICAL PACKAGES. 
(a) IN GENERAL.—Section 1848(c) of the Social Se-
curity Act (42 U.S.C. 1395w–4(c)) is amended by adding 
at the end the following new paragraph: 
‘‘(8) GLOBAL SURGICAL PACKAGES.— 
‘‘(A) PROHIBITION
OF
IMPLEMENTATION 
OF RULE REGARDING GLOBAL SURGICAL PACK-
AGES.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall not implement the policy established 
in the final rule published on November 
13, 2014 (79 Fed. Reg. 67548 et seq.), 
that requires the transition of all 10-day 
and 90-day global surgery packages to 0- 
day global periods.
254 
‘‘(ii) 
CONSTRUCTION.—Nothing 
in 
clause (i) shall be construed to prevent the 
Secretary from revaluing misvalued codes 
for specific surgical services or assigning 
values to new or revised codes for surgical 
services. 
‘‘(B) COLLECTION OF DATA ON SERVICES 
INCLUDED IN GLOBAL SURGICAL PACKAGES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall through rule-
making develop and implement a process 
to gather, from a representative sample of 
physicians, beginning not later than Janu-
ary 1, 2017, information needed to value 
surgical services. Such information shall 
include the number and level of medical 
visits furnished during the global period 
and other items and services related to the 
surgery and furnished during the global 
period, as appropriate. Such information 
shall be reported on claims at the end of 
the global period or in another manner 
specified by the Secretary. For purposes of 
carrying out this paragraph (other than 
clause (iii)), the Secretary shall transfer
255 
from the Federal Supplemental Medical In-
surance Trust Fund under section 1841 
$2,000,000 to the Center for Medicare & 
Medicaid Services Program Management 
Account for fiscal year 2015. Amounts 
transferred under the previous sentence 
shall remain available until expended. 
‘‘(ii) REASSESSMENT AND POTENTIAL 
SUNSET.—Every 4 years, the Secretary 
shall reassess the value of the information 
collected pursuant to clause (i). Based on 
such a reassessment and by regulation, the 
Secretary may discontinue the requirement 
for collection of information under such 
clause if the Secretary determines that the 
Secretary has adequate information from 
other sources, such as qualified clinical 
data registries, surgical logs, billing sys-
tems or other practice or facility records, 
and electronic health records, in order to 
accurately value global surgical services 
under this section. 
‘‘(iii) INSPECTOR GENERAL AUDIT.— 
The Inspector General of the Department 
of Health and Human Services shall audit
256 
a sample of the information reported under 
clause (i) to verify the accuracy of the in-
formation so reported. 
‘‘(C) IMPROVING
ACCURACY
OF
PRICING 
FOR SURGICAL SERVICES.—For years beginning 
with 2019, the Secretary shall use the informa-
tion reported under subparagraph (B)(i) as ap-
propriate and other available data for the pur-
pose of improving the accuracy of valuation of 
surgical services under the physician fee sched-
ule under this section.’’. 
(b) INCENTIVE FOR REPORTING INFORMATION ON 
GLOBAL SURGICAL SERVICES.—Section 1848(a) of the 
Social Security Act (42 U.S.C. 1395w–4(a)) is amended 
by adding at the end the following new paragraph: 
‘‘(9) INFORMATION
REPORTING
ON
SERVICES 
INCLUDED IN GLOBAL SURGICAL PACKAGES.—With 
respect to services for which a physician is required 
to report information in accordance with subsection 
(c)(8)(B)(i), the Secretary may through rulemaking 
delay payment of 5 percent of the amount that 
would otherwise be payable under the physician fee 
schedule under this section for such services until 
the information so required is reported.’’.
257 
SEC. 524. EXTENSION OF SECURE RURAL SCHOOLS AND 
COMMUNITY SELF-DETERMINATION ACT OF 
2000. 
(a) PAYMENTS
FOR
FISCAL
YEARS
2014 AND 
2015.— 
(1) PAYMENTS REQUIRED.—Section 101 of the 
Secure Rural Schools and Community Self-Deter-
mination Act of 2000 (16 U.S.C. 7111) is amended 
by striking ‘‘2013’’ both places it appears and in-
serting ‘‘2015’’. 
(2) PROMPT
PAYMENT.—Payments for fiscal 
year 2014 under title I of the Secure Rural Schools 
and Community Self-Determination Act of 2000 (16 
U.S.C. 7111 et seq.), as amended by this section, 
shall be made not later than 45 days after the date 
of the enactment of this Act. 
(3) REDUCTION
IN
FISCAL
YEAR
2014
PAY-
MENTS ON ACCOUNT OF PREVIOUS 25- AND 50-PER-
CENT PAYMENTS.—Section 101 of the Secure Rural 
Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7111) is amended by adding at the 
end the following new subsection: 
‘‘(c) SPECIAL RULE FOR FISCAL YEAR 2014 PAY-
MENTS.— 
‘‘(1) STATE PAYMENT.—If an eligible county in 
a State that will receive a share of the State pay-
258 
ment for fiscal year 2014 has already received, or 
will receive, a share of the 25-percent payment for 
fiscal year 2014 distributed to the State before the 
date of the enactment of this subsection, the amount 
of the State payment shall be reduced by the 
amount of that eligible county’s share of the 25-per-
cent payment. 
‘‘(2) COUNTY PAYMENT.—If an eligible county 
that will receive a county payment for fiscal year 
2014 has already received a 50-percent payment for 
that fiscal year, the amount of the county payment 
shall be reduced by the amount of the 50-percent 
payment.’’. 
(4) SHARES
OF
CALIFORNIA
STATE
PAY-
MENT.—Section 103(d)(2) of the Secure Rural 
Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7113(d)(2)) is amended by striking 
‘‘2013’’ and inserting ‘‘2015’’. 
(b) USE OF FISCAL YEAR 2013 ELECTIONS AND 
RESERVATIONS FOR FISCAL YEARS 2014 AND 2015.— 
Section 102 of the Secure Rural Schools and Community 
Self-Determination Act of 2000 (16 U.S.C. 7112) is 
amended— 
(1) in subsection (b)(1), by adding at the end 
the following new subparagraph:
259 
‘‘(C) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEARS 2014 AND 2015.—The election other-
wise required by subparagraph (A) shall not 
apply for fiscal year 2014 or 2015.’’; 
(2) in subsection (b)(2)— 
(A) in subparagraph (A), by adding at the 
end the following new sentence: ‘‘If such two- 
fiscal year period included fiscal year 2013, the 
county election to receive a share of the 25-per-
cent payment or 50-percent payment, as appli-
cable, also shall be effective for fiscal years 
2014 and 2015.’’; and 
(B) in subparagraph (B), by striking 
‘‘2013’’ the second place it appears and insert-
ing ‘‘2015’’; and 
(3) in subsection (d)— 
(A) by adding at the end of paragraph (1) 
the following new subparagraph: 
‘‘(E) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEAR 2014.—The election made by an eligi-
ble county under subparagraph (B), (C), or (D) 
for fiscal year 2013, or deemed to be made by 
the county under paragraph (3)(B) for that fis-
cal year, shall be effective for fiscal years 2014 
and 2015.’’; and
260 
(B) by adding at the end of paragraph (3) 
the following new subparagraph: 
‘‘(C) EFFECT OF LATE PAYMENT FOR FIS-
CAL YEAR 2014.—This paragraph does not apply 
for fiscal years 2014 and 2015.’’. 
(c) SPECIAL PROJECTS ON FEDERAL LAND.—Title 
II of the Secure Rural Schools and Community Self-Deter-
mination Act of 2000 (16 U.S.C. 7121 et seq.) is amend-
ed— 
(1) 
in 
section 
203(a)(1) 
(16 
U.S.C. 
7123(a)(1)), by striking ‘‘September 30 for fiscal 
year 2008 (or as soon thereafter as the Secretary 
concerned determines is practicable), and each Sep-
tember 30 thereafter for each succeeding fiscal year 
through fiscal year 2013’’ and inserting ‘‘September 
30 of each fiscal year (or a later date specified by 
the Secretary concerned for the fiscal year)’’; 
(2) in section 204(e)(3)(B)(iii) (16 U.S.C. 
7124(e)(3)(B)(iii)), by striking ‘‘each of fiscal years 
2010 through 2013’’ and inserting ‘‘fiscal year 2010 
and fiscal years thereafter’’; 
(3) in section 207(a) (16 U.S.C. 7127(a)), by 
striking ‘‘September 30, 2008 (or as soon thereafter 
as the Secretary concerned determines is prac-
ticable), and each September 30 thereafter for each
261 
succeeding fiscal year through fiscal year 2013’’ and 
inserting ‘‘September 30 of each fiscal year (or a 
later date specified by the Secretary concerned for 
the fiscal year)’’; and 
(4) in section 208 (16 U.S.C. 7128)— 
(A) in subsection (a), by striking ‘‘2013’’ 
and inserting ‘‘2017’’; and 
(B) in subsection (b), by striking ‘‘2014’’ 
and inserting ‘‘2018’’. 
(d) COUNTY FUNDS.—Section 304 of the Secure 
Rural Schools and Community Self-Determination Act of 
2000 (16 U.S.C. 7144) is amended— 
(1) in subsection (a), by striking ‘‘2013’’ and 
inserting ‘‘2017’’; and 
(2) in subsection (b), by striking ‘‘2014’’ and 
inserting ‘‘2018’’. 
(e) AUTHORIZATION OF APPROPRIATIONS.—Section 
402 of the Secure Rural Schools and Community Self-De-
termination Act of 2000 (16 U.S.C. 7152) is amended by 
striking ‘‘for each of fiscal years 2008 through 2013’’. 
SEC. 525. EXCLUSION FROM PAYGO SCORECARDS. 
(a) STATUTORY PAY-AS-YOU-GO SCORECARDS.—The 
budgetary effects of this Act shall not be entered on either 
PAYGO scorecard maintained pursuant to section 4(d) of 
the Statutory Pay-As-You-Go Act of 2010.
262 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this Act shall not be entered on any PAYGO 
scorecard maintained for purposes of section 201 of S. 
Con. Res. 21 (110th Congress). 
Passed the House of Representatives March 26, 
2015. 
Attest: 
Clerk.
114TH CONGRESS 
1ST SESSION 
H. R. 2 
AN ACT 
To amend title XVIII of the Social Security Act to 
repeal the Medicare sustainable growth rate and 
strengthen Medicare access by improving physi-
cian payments and making other improvements, 
to reauthorize the Children’s Health Insurance 
Program, and for other purposes.