II 
113TH CONGRESS 
2D SESSION 
H. R. 4015 
IN THE SENATE OF THE UNITED STATES 
MARCH 24, 2014 
Received 
AN ACT 
To amend title XVIII of the Social Security Act to repeal 
the Medicare sustainable growth rate and improve Medi-
care payments for physicians and other professionals, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘SGR Repeal and Medicare Provider Payment Moderniza-
tion Act of 2014’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Repealing the sustainable growth rate (SGR) and improving Medicare 
payment for physicians’ services. 
Sec. 3. Priorities and funding for measure development. 
Sec. 4. Encouraging care management for individuals with chronic care needs. 
Sec. 5. Ensuring accurate valuation of services under the physician fee sched-
ule. 
Sec. 6. Promoting evidence-based care. 
Sec. 7. Empowering beneficiary choices through access to information on physi-
cians’ services. 
Sec. 8. Expanding availability of Medicare data. 
Sec. 9. Reducing administrative burden and other provisions. 
Sec. 10. Delay in implementation of penalty for failure to comply with indi-
vidual health insurance mandate. 
SEC. 2. REPEALING THE SUSTAINABLE GROWTH RATE 
(SGR) AND IMPROVING MEDICARE PAYMENT 
FOR PHYSICIANS’ SERVICES. 
(a) STABILIZING FEE UPDATES.— 
(1) REPEAL
OF
SGR
PAYMENT
METHOD-
OLOGY.—Section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended— 
(A) in subsection (d)— 
(i) in paragraph (1)(A), by inserting 
‘‘or a subsequent paragraph’’ after ‘‘para-
graph (4)’’; and 
(ii) in paragraph (4)— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(I) in the heading, by inserting 
‘‘AND
ENDING
WITH
2013’’ after 
‘‘YEARS BEGINNING WITH 2001’’; and 
(II) in subparagraph (A), by in-
serting ‘‘and ending with 2013’’ after 
‘‘a year beginning with 2001’’; and 
(B) in subsection (f)— 
(i) in paragraph (1)(B), by inserting 
‘‘through 2013’’ after ‘‘of each succeeding 
year’’; and 
(ii) in paragraph (2), in the matter 
preceding subparagraph (A), by inserting 
‘‘and ending with 2013’’ after ‘‘beginning 
with 2000’’. 
(2) UPDATE OF RATES FOR APRIL THROUGH 
DECEMBER
OF
2014, 
2015, 
AND
SUBSEQUENT 
YEARS.—Subsection (d) of section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4) is amended by 
striking paragraph (15) and inserting the following 
new paragraphs: 
‘‘(15) UPDATE FOR 2014 THROUGH 2018.—The 
update to the single conversion factor established in 
paragraph (1)(C) for 2014 and each subsequent 
year through 2018 shall be 0.5 percent. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(16) UPDATE FOR 2019 THROUGH 2023.—The 
update to the single conversion factor established in 
paragraph (1)(C) for 2019 and each subsequent 
year through 2023 shall be zero percent. 
‘‘(17) UPDATE
FOR
2024
AND
SUBSEQUENT 
YEARS.—The update to the single conversion factor 
established in paragraph (1)(C) for 2024 and each 
subsequent year shall be— 
‘‘(A) for items and services furnished by a 
qualifying APM participant (as defined in sec-
tion 1833(z)(2)) for such year, 1.0 percent; and 
‘‘(B) for other items and services, 0.5 per-
cent.’’. 
(3) MEDPAC REPORTS.— 
(A) INITIAL REPORT.—Not later than July 
1, 2016, the Medicare Payment Advisory Com-
mission shall submit to Congress a report on 
the relationship between— 
(i) physician and other health profes-
sional utilization and expenditures (and the 
rate of increase of such utilization and ex-
penditures) of items and services for which 
payment is made under section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4); 
and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(ii) total utilization and expenditures 
(and the rate of increase of such utilization 
and expenditures) under parts A, B, and D 
of title XVIII of such Act. 
Such report shall include a methodology to de-
scribe such relationship and the impact of 
changes in such physician and other health pro-
fessional practice and service ordering patterns 
on total utilization and expenditures under 
parts A, B, and D of such title. 
(B) FINAL REPORT.—Not later than July 
1, 2020, the Medicare Payment Advisory Com-
mission shall submit to Congress a report on 
the relationship described in subparagraph (A), 
including the results determined from applying 
the methodology included in the report sub-
mitted under such subparagraph. 
(C) REPORT ON UPDATE TO PHYSICIANS’ 
SERVICES UNDER MEDICARE.—Not later than 
July 1, 2018, the Medicare Payment Advisory 
Commission shall submit to Congress a report 
on— 
(i) the payment update for profes-
sional services applied under the Medicare 
program under title XVIII of the Social 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
Security Act for the period of years 2014 
through 2018; 
(ii) the effect of such update on the 
efficiency, economy, and quality of care 
provided under such program; 
(iii) the effect of such update on en-
suring a sufficient number of providers to 
maintain access to care by Medicare bene-
ficiaries; and 
(iv) recommendations for any future 
payment updates for professional services 
under such program to ensure adequate 
access to care is maintained for Medicare 
beneficiaries. 
(b) CONSOLIDATION
OF CERTAIN CURRENT LAW 
PERFORMANCE PROGRAMS WITH NEW MERIT-BASED IN-
CENTIVE PAYMENT SYSTEM.— 
(1) EHR MEANINGFUL USE INCENTIVE PRO-
GRAM.— 
(A) SUNSETTING SEPARATE MEANINGFUL 
USE
PAYMENT
ADJUSTMENTS.—Section 
1848(a)(7)(A) of the Social Security Act (42 
U.S.C. 1395w–4(a)(7)(A)) is amended— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(i) in clause (i), by striking ‘‘or any 
subsequent payment year’’ and inserting 
‘‘or 2017’’; 
(ii) in clause (ii)— 
(I) in the matter preceding sub-
clause (I), by striking ‘‘Subject to 
clause (iii), for’’ and inserting ‘‘For’’; 
(II) in subclause (I), by adding 
at the end ‘‘and’’; 
(III) in subclause (II), by strik-
ing ‘‘; and’’ and inserting a period; 
and 
(IV) by striking subclause (III); 
and 
(iii) by striking clause (iii). 
(B) CONTINUATION OF MEANINGFUL USE 
DETERMINATIONS
FOR
MIPS.—Section 
1848(o)(2) of the Social Security Act (42 
U.S.C. 1395w–4(o)(2)) is amended— 
(i) in subparagraph (A), in the matter 
preceding clause (i)— 
(I) by striking ‘‘For purposes of 
paragraph (1), an’’ and inserting 
‘‘An’’; and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(II) by inserting ‘‘, or pursuant 
to subparagraph (D) for purposes of 
subsection (q), for a performance pe-
riod under such subsection for a year’’ 
after ‘‘under such subsection for a 
year’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(D) CONTINUED APPLICATION FOR PUR-
POSES
OF
MIPS.—With respect to 2018 and 
each subsequent payment year, the Secretary 
shall, for purposes of subsection (q) and in ac-
cordance with paragraph (1)(F) of such sub-
section, determine whether an eligible profes-
sional who is a MIPS eligible professional (as 
defined in subsection (q)(1)(C)) for such year is 
a meaningful EHR user under this paragraph 
for the performance period under subsection (q) 
for such year.’’. 
(2) QUALITY REPORTING.— 
(A) SUNSETTING SEPARATE QUALITY RE-
PORTING
INCENTIVES.—Section 1848(a)(8)(A) 
of the Social Security Act (42 U.S.C. 1395w– 
4(a)(8)(A)) is amended— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(i) in clause (i), by striking ‘‘or any 
subsequent year’’ and inserting ‘‘or 2017’’; 
and 
(ii) in clause (ii)(II), by striking ‘‘and 
each subsequent year’’. 
(B) CONTINUATION
OF
QUALITY
MEAS-
URES
AND
PROCESSES
FOR
MIPS.—Section 
1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(i) in subsection (k), by adding at the 
end the following new paragraph: 
‘‘(9) CONTINUED APPLICATION FOR PURPOSES 
OF MIPS AND FOR CERTAIN PROFESSIONALS VOLUN-
TEERING TO REPORT.—The Secretary shall, in ac-
cordance with subsection (q)(1)(F), carry out the 
provisions of this subsection— 
‘‘(A) for purposes of subsection (q); and 
‘‘(B) for eligible professionals who are not 
MIPS eligible professionals (as defined in sub-
section (q)(1)(C)) for the year involved.’’; and 
(ii) in subsection (m)— 
(I) by redesignating paragraph 
(7) added by section 10327(a) of Pub-
lic Law 111–148 as paragraph (8); 
and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(II) by adding at the end the fol-
lowing new paragraph: 
‘‘(9) CONTINUED APPLICATION FOR PURPOSES 
OF MIPS AND FOR CERTAIN PROFESSIONALS VOLUN-
TEERING TO REPORT.—The Secretary shall, in ac-
cordance with subsection (q)(1)(F), carry out the 
processes under this subsection— 
‘‘(A) for purposes of subsection (q); and 
‘‘(B) for eligible professionals who are not 
MIPS eligible professionals (as defined in sub-
section (q)(1)(C)) for the year involved.’’. 
(3) VALUE-BASED PAYMENTS.— 
(A) SUNSETTING SEPARATE VALUE-BASED 
PAYMENTS.—Clause 
(iii) 
of 
section 
1848(p)(4)(B) of the Social Security Act (42 
U.S.C. 1395w–4(p)(4)(B)) is amended to read 
as follows: 
‘‘(iii) APPLICATION.—The Secretary 
shall apply the payment modifier estab-
lished under this subsection for items and 
services furnished on or after January 1, 
2015, but before January 1, 2018, with re-
spect to specific physicians and groups of 
physicians the Secretary determines appro-
priate. Such payment modifier shall not be 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
applied for items and services furnished on 
or after January 1, 2018.’’. 
(B) CONTINUATION OF VALUE-BASED PAY-
MENT MODIFIER MEASURES FOR MIPS.—Section 
1848(p) of the Social Security Act (42 U.S.C. 
1395w–4(p)) is amended— 
(i) in paragraph (2), by adding at the 
end the following new subparagraph: 
‘‘(C) CONTINUED APPLICATION FOR PUR-
POSES OF MIPS.—The Secretary shall, in ac-
cordance with subsection (q)(1)(F), carry out 
subparagraph (B) for purposes of subsection 
(q).’’; and 
(ii) in paragraph (3), by adding at the 
end the following: ‘‘With respect to 2018 
and each subsequent year, the Secretary 
shall, 
in 
accordance 
with 
subsection 
(q)(1)(F), carry out this paragraph for 
purposes of subsection (q).’’. 
(c) MERIT-BASED INCENTIVE PAYMENT SYSTEM.— 
(1) IN GENERAL.—Section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4) is amended by 
adding at the end the following new subsection: 
‘‘(q) MERIT-BASED INCENTIVE PAYMENT SYSTEM.— 
‘‘(1) ESTABLISHMENT.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, the Sec-
retary shall establish an eligible professional 
Merit-based Incentive Payment System (in this 
subsection referred to as the ‘MIPS’) under 
which the Secretary shall— 
‘‘(i) develop a methodology for assess-
ing the total performance of each MIPS el-
igible professional according to perform-
ance standards under paragraph (3) for a 
performance period (as established under 
paragraph (4)) for a year; 
‘‘(ii) using such methodology, provide 
for a composite performance score in ac-
cordance with paragraph (5) for each such 
professional for each performance period; 
and 
‘‘(iii) use such composite performance 
score of the MIPS eligible professional for 
a performance period for a year to deter-
mine and apply a MIPS adjustment factor 
(and, as applicable, an additional MIPS 
adjustment factor) under paragraph (6) to 
the professional for the year. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(B) PROGRAM
IMPLEMENTATION.—The 
MIPS shall apply to payments for items and 
services furnished on or after January 1, 2018. 
‘‘(C) MIPS ELIGIBLE PROFESSIONAL DE-
FINED.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, subject to clauses (ii) and 
(iv), the term ‘MIPS eligible professional’ 
means— 
‘‘(I) for the first and second 
years for which the MIPS applies to 
payments (and for the performance 
period for such first and second year), 
a physician (as defined in section 
1861(r)), a physician assistant, nurse 
practitioner, and clinical nurse spe-
cialist (as such terms are defined in 
section 1861(aa)(5)), and a certified 
registered nurse anesthetist (as de-
fined in section 1861(bb)(2)) and a 
group that includes such profes-
sionals; and 
‘‘(II) for the third year for which 
the MIPS applies to payments (and 
for the performance period for such 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
third year) and for each succeeding 
year (and for the performance period 
for each such year), the professionals 
described in subclause (I) and such 
other eligible professionals (as defined 
in subsection (k)(3)(B)) as specified 
by the Secretary and a group that in-
cludes such professionals. 
‘‘(ii) EXCLUSIONS.—For purposes of 
clause (i), the term ‘MIPS eligible profes-
sional’ does not include, with respect to a 
year, an eligible professional (as defined in 
subsection (k)(3)(B)) who— 
‘‘(I) is a qualifying APM partici-
pant 
(as 
defined 
in 
section 
1833(z)(2)); 
‘‘(II) subject to clause (vii), is a 
partial qualifying APM participant (as 
defined in clause (iii)) for the most re-
cent period for which data are avail-
able and who, for the performance pe-
riod with respect to such year, does 
not report on applicable measures and 
activities 
described 
in 
paragraph 
(2)(B) that are required to be re-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
ported by such a professional under 
the MIPS; or 
‘‘(III) for the performance period 
with respect to such year, does not ex-
ceed the low-volume threshold meas-
urement selected under clause (iv). 
‘‘(iii) PARTIAL QUALIFYING APM PAR-
TICIPANT.—For purposes of this subpara-
graph, the term ‘partial qualifying APM 
participant’ means, with respect to a year, 
an eligible professional for whom the Sec-
retary determines the minimum payment 
percentage (or percentages), as applicable, 
described in paragraph (2) of section 
1833(z) for such year have not been satis-
fied, but who would be considered a quali-
fying APM participant (as defined in such 
paragraph) for such year if— 
‘‘(I) with respect to 2018 and 
2019, the reference in subparagraph 
(A) of such paragraph to 25 percent 
was instead a reference to 20 percent; 
‘‘(II) with respect to 2020 and 
2021— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(aa) the reference in sub-
paragraph (B)(i) of such para-
graph to 50 percent was instead 
a reference to 40 percent; and 
‘‘(bb) the references in sub-
paragraph (B)(ii) of such para-
graph to 50 percent and 25 per-
cent of such paragraph were in-
stead references to 40 percent 
and 20 percent, respectively; and 
‘‘(III) with respect to 2022 and 
subsequent years— 
‘‘(aa) the reference in sub-
paragraph (C)(i) of such para-
graph to 75 percent was instead 
a reference to 50 percent; and 
‘‘(bb) the references in sub-
paragraph (C)(ii) of such para-
graph to 75 percent and 25 per-
cent of such paragraph were in-
stead references to 50 percent 
and 20 percent, respectively. 
‘‘(iv) SELECTION
OF
LOW-VOLUME 
THRESHOLD
MEASUREMENT.—The Sec-
retary shall select a low-volume threshold 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
to apply for purposes of clause (ii)(III), 
which may include one or more or a com-
bination of the following: 
‘‘(I) The minimum number (as 
determined by the Secretary) of indi-
viduals enrolled under this part who 
are treated by the eligible professional 
for the performance period involved. 
‘‘(II) The minimum number (as 
determined by the Secretary) of items 
and services furnished to individuals 
enrolled under this part by such pro-
fessional for such performance period. 
‘‘(III) The minimum amount (as 
determined by the Secretary) of al-
lowed charges billed by such profes-
sional under this part for such per-
formance period. 
‘‘(v) TREATMENT OF NEW MEDICARE 
ENROLLED ELIGIBLE PROFESSIONALS.—In 
the case of a professional who first be-
comes a Medicare enrolled eligible profes-
sional during the performance period for a 
year (and had not previously submitted 
claims under this title such as a person, an 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
entity, or a part of a physician group or 
under a different billing number or tax 
identifier), such professional shall not be 
treated under this subsection as a MIPS 
eligible professional until the subsequent 
year and performance period for such sub-
sequent year. 
‘‘(vi) CLARIFICATION.—In the case of 
items and services furnished during a year 
by an individual who is not a MIPS eligible 
professional (including pursuant to clauses 
(ii) and (v)) with respect to a year, in no 
case shall a MIPS adjustment factor (or 
additional MIPS adjustment factor) under 
paragraph (6) apply to such individual for 
such year. 
‘‘(vii) PARTIAL QUALIFYING APM PAR-
TICIPANT CLARIFICATIONS.— 
‘‘(I) TREATMENT AS MIPS ELIGI-
BLE PROFESSIONAL.—In the case of 
an eligible professional who is a par-
tial qualifying APM participant, with 
respect to a year, and who for the 
performance period for such year re-
ports on applicable measures and ac-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
tivities described in paragraph (2)(B) 
that are required to be reported by 
such a professional under the MIPS, 
such eligible professional is considered 
to be a MIPS eligible professional 
with respect to such year. 
‘‘(II) NOT ELIGIBLE FOR QUALI-
FYING
APM
PARTICIPANT
PAY-
MENTS.—In no case shall an eligible 
professional who is a partial quali-
fying APM participant, with respect 
to a year, be considered a qualifying 
APM participant (as defined in para-
graph (2) of section 1833(z)) for such 
year or be eligible for the additional 
payment under paragraph (1) of such 
section for such year. 
‘‘(D) APPLICATION
TO
GROUP
PRAC-
TICES.— 
‘‘(i) IN GENERAL.—Under the MIPS: 
‘‘(I) 
QUALITY
PERFORMANCE 
CATEGORY.—The Secretary shall es-
tablish and apply a process that in-
cludes features of the provisions of 
subsection (m)(3)(C) for MIPS eligi-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
ble professionals in a group practice 
with respect to assessing performance 
of such group with respect to the per-
formance category described in clause 
(i) of paragraph (2)(A). 
‘‘(II) OTHER PERFORMANCE CAT-
EGORIES.—The Secretary may estab-
lish and apply a process that includes 
features of the provisions of sub-
section (m)(3)(C) for MIPS eligible 
professionals in a group practice with 
respect to assessing the performance 
of such group with respect to the per-
formance 
categories 
described 
in 
clauses (ii) through (iv) of such para-
graph. 
‘‘(ii) ENSURING COMPREHENSIVENESS 
OF
GROUP
PRACTICE
ASSESSMENT.—The 
process established under clause (i) shall to 
the extent practicable reflect the range of 
items and services furnished by the MIPS 
eligible professionals in the group practice 
involved. 
‘‘(iii) CLARIFICATION.—MIPS eligible 
professionals electing to be a virtual group 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
under paragraph (5)(I) shall not be consid-
ered MIPS eligible professionals in a group 
practice for purposes of applying this sub-
paragraph. 
‘‘(E) USE
OF
REGISTRIES.—Under the 
MIPS, the Secretary shall encourage the use of 
qualified clinical data registries pursuant to 
subsection (m)(3)(E) in carrying out this sub-
section. 
‘‘(F) APPLICATION
OF
CERTAIN
PROVI-
SIONS.—In applying a provision of subsection 
(k), (m), (o), or (p) for purposes of this sub-
section, the Secretary shall— 
‘‘(i) adjust the application of such 
provision to ensure the provision is con-
sistent with the provisions of this sub-
section; and 
‘‘(ii) not apply such provision to the 
extent that the provision is duplicative with 
a provision of this subsection. 
‘‘(G) ACCOUNTING FOR RISK FACTORS.— 
‘‘(i) RISK FACTORS.—Taking into ac-
count the relevant studies conducted and 
recommendations made in reports under 
section 2(f)(1) of the SGR Repeal and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
Medicare Provider Payment Modernization 
Act of 2014, the Secretary, on an ongoing 
basis, shall estimate how an individual’s 
health status and other risk factors affect 
quality and resource use outcome measures 
and, as feasible, shall incorporate informa-
tion from quality and resource use outcome 
measurement (including care episode and 
patient condition groups) into the MIPS. 
‘‘(ii) ACCOUNTING FOR OTHER FAC-
TORS
IN
PAYMENT
ADJUSTMENTS.—Tak-
ing into account the studies conducted and 
recommendations made in reports under 
section 2(f)(1) of the SGR Repeal and 
Medicare Provider Payment Modernization 
Act of 2014 and other information as ap-
propriate, the Secretary shall account for 
identified factors with an effect on quality 
and resource use outcome measures when 
determining payment adjustments, com-
posite performance scores, scores for per-
formance categories, or scores for meas-
ures or activities under the MIPS. 
‘‘(2) MEASURES AND ACTIVITIES UNDER PER-
FORMANCE CATEGORIES.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(A) PERFORMANCE CATEGORIES.—Under 
the MIPS, the Secretary shall use the following 
performance categories (each of which is re-
ferred to in this subsection as a performance 
category) in determining the composite per-
formance score under paragraph (5): 
‘‘(i) Quality. 
‘‘(ii) Resource use. 
‘‘(iii) Clinical practice improvement 
activities. 
‘‘(iv) Meaningful use of certified EHR 
technology. 
‘‘(B) MEASURES
AND
ACTIVITIES
SPECI-
FIED FOR EACH CATEGORY.—For purposes of 
paragraph (3)(A) and subject to subparagraph 
(C), measures and activities specified for a per-
formance period (as established under para-
graph (4)) for a year are as follows: 
‘‘(i) QUALITY.—For the performance 
category described in subparagraph (A)(i), 
the quality measures included in the final 
measures list published under subpara-
graph (D)(i) for such year and the list of 
quality measures described in subpara-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
graph (D)(vi) used by qualified clinical 
data registries under subsection (m)(3)(E). 
‘‘(ii) RESOURCE USE.—For the per-
formance category described in subpara-
graph (A)(ii), the measurement of resource 
use for such period under subsection 
(p)(3), using the methodology under sub-
section (r) as appropriate, and, as feasible 
and applicable, accounting for the cost of 
drugs under part D. 
‘‘(iii) CLINICAL
PRACTICE
IMPROVE-
MENT
ACTIVITIES.—For the performance 
category 
described 
in 
subparagraph 
(A)(iii), clinical practice improvement ac-
tivities 
(as 
defined 
in 
subparagraph 
(C)(v)(III)) under subcategories specified 
by the Secretary for such period, which 
shall include at least the following: 
‘‘(I) The subcategory of expanded 
practice access, which shall include ac-
tivities such as same day appoint-
ments for urgent needs and after 
hours access to clinician advice. 
‘‘(II) The subcategory of popu-
lation management, which shall in-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
clude activities such as monitoring 
health conditions of individuals to pro-
vide timely health care interventions 
or participation in a qualified clinical 
data registry. 
‘‘(III) The subcategory of care 
coordination, which shall include ac-
tivities such as timely communication 
of test results, timely exchange of 
clinical information to patients and 
other providers, and use of remote 
monitoring or telehealth. 
‘‘(IV) The subcategory of bene-
ficiary engagement, which shall in-
clude activities such as the establish-
ment of care plans for individuals 
with complex care needs, beneficiary 
self-management 
assessment 
and 
training, and using shared decision- 
making mechanisms. 
‘‘(V) The subcategory of patient 
safety and practice assessment, such 
as through use of clinical or surgical 
checklists and practice assessments 
related to maintaining certification. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(VI) The subcategory of partici-
pation in an alternative payment 
model 
(as 
defined 
in 
section 
1833(z)(3)(C)). 
In establishing activities under this clause, 
the Secretary shall give consideration to 
the circumstances of small practices (con-
sisting of 15 or fewer professionals) and 
practices located in rural areas and in 
health professional shortage areas (as des-
ignated under section 332(a)(1)(A) of the 
Public Health Service Act). 
‘‘(iv) MEANINGFUL
EHR
USE.—For 
the performance category described in sub-
paragraph (A)(iv), the requirements estab-
lished for such period under subsection 
(o)(2) for determining whether an eligible 
professional is a meaningful EHR user. 
‘‘(C) ADDITIONAL PROVISIONS.— 
‘‘(i) EMPHASIZING
OUTCOME
MEAS-
URES UNDER THE QUALITY PERFORMANCE 
CATEGORY.—In 
applying 
subparagraph 
(B)(i), the Secretary shall, as feasible, em-
phasize the application of outcome meas-
ures. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(ii) APPLICATION
OF
ADDITIONAL 
SYSTEM
MEASURES.—The Secretary may 
use measures used for a payment system 
other than for physicians, such as meas-
ures for inpatient hospitals, for purposes of 
the performance categories described in 
clauses (i) and (ii) of subparagraph (A). 
For purposes of the previous sentence, the 
Secretary may not use measures for hos-
pital outpatient departments, except in the 
case of emergency physicians. 
‘‘(iii) 
GLOBAL
AND
POPULATION- 
BASED
MEASURES.—The Secretary may 
use global measures, such as global out-
come 
measures, 
and 
population-based 
measures for purposes of the performance 
category described in subparagraph (A)(i). 
‘‘(iv) APPLICATION OF MEASURES AND 
ACTIVITIES TO NON-PATIENT-FACING PRO-
FESSIONALS.—In carrying out this para-
graph, with respect to measures and activi-
ties specified in subparagraph (B) for per-
formance categories described in subpara-
graph (A), the Secretary— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(I) shall give consideration to 
the 
circumstances 
of 
professional 
types (or subcategories of those types 
determined by practice characteris-
tics) who typically furnish services 
that do not involve face-to-face inter-
action with a patient; and 
‘‘(II) may, to the extent feasible 
and appropriate, take into account 
such circumstances and apply under 
this subsection with respect to MIPS 
eligible professionals of such profes-
sional types or subcategories, alter-
native measures or activities that ful-
fill the goals of the applicable per-
formance category. 
In carrying out the previous sentence, the 
Secretary shall consult with professionals 
of such professional types or subcategories. 
‘‘(v) CLINICAL
PRACTICE
IMPROVE-
MENT ACTIVITIES.— 
‘‘(I) REQUEST
FOR
INFORMA-
TION.—In initially applying subpara-
graph (B)(iii), the Secretary shall use 
a request for information to solicit 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
recommendations from stakeholders to 
identify activities described in such 
subparagraph and specifying criteria 
for such activities. 
‘‘(II) CONTRACT AUTHORITY FOR 
CLINICAL
PRACTICE
IMPROVEMENT 
ACTIVITIES
PERFORMANCE
CAT-
EGORY.—In applying subparagraph 
(B)(iii), the Secretary may contract 
with entities to assist the Secretary 
in— 
‘‘(aa) identifying activities 
described 
in 
subparagraph 
(B)(iii); 
‘‘(bb) specifying criteria for 
such activities; and 
‘‘(cc) determining whether a 
MIPS eligible professional meets 
such criteria. 
‘‘(III) CLINICAL
PRACTICE
IM-
PROVEMENT
ACTIVITIES
DEFINED.— 
For purposes of this subsection, the 
term ‘clinical practice improvement 
activity’ means an activity that rel-
evant eligible professional organiza-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
tions and other relevant stakeholders 
identify as improving clinical practice 
or care delivery and that the Sec-
retary determines, when effectively ex-
ecuted, is likely to result in improved 
outcomes. 
‘‘(D) ANNUAL LIST OF QUALITY MEASURES 
AVAILABLE FOR MIPS ASSESSMENT.— 
‘‘(i) IN GENERAL.—Under the MIPS, 
the Secretary, through notice and comment 
rulemaking and subject to the succeeding 
clauses of this subparagraph, shall, with 
respect to the performance period for a 
year, establish an annual final list of qual-
ity measures from which MIPS eligible 
professionals may choose for purposes of 
assessment under this subsection for such 
performance period. Pursuant to the pre-
vious sentence, the Secretary shall— 
‘‘(I) not later than November 1 
of the year prior to the first day of 
the first performance period under the 
MIPS, establish and publish in the 
Federal Register a final list of quality 
measures; and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(II) not later than November 1 
of the year prior to the first day of 
each subsequent performance period, 
update the final list of quality meas-
ures from the previous year (and pub-
lish such updated final list in the Fed-
eral Register), by— 
‘‘(aa) removing from such 
list, as appropriate, quality meas-
ures, which may include the re-
moval of measures that are no 
longer meaningful (such as meas-
ures that are topped out); 
‘‘(bb) adding to such list, as 
appropriate, new quality meas-
ures; and 
‘‘(cc) determining whether 
or not quality measures on such 
list that have undergone sub-
stantive changes should be in-
cluded in the updated list. 
‘‘(ii) 
CALL
FOR
QUALITY
MEAS-
URES.— 
‘‘(I) IN GENERAL.—Eligible pro-
fessional organizations and other rel-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
evant stakeholders shall be requested 
to identify and submit quality meas-
ures to be considered for selection 
under this subparagraph in the an-
nual list of quality measures published 
under clause (i) and to identify and 
submit updates to the measures on 
such list. For purposes of the previous 
sentence, measures may be submitted 
regardless of whether such measures 
were previously published in a pro-
posed rule or endorsed by an entity 
with a contract under section 1890(a). 
‘‘(II) ELIGIBLE
PROFESSIONAL 
ORGANIZATION
DEFINED.—In 
this 
subparagraph, the term ‘eligible pro-
fessional organization’ means a pro-
fessional organization as defined by 
nationally recognized multispecialty 
boards of certification or equivalent 
certification boards. 
‘‘(iii) REQUIREMENTS.—In selecting 
quality measures for inclusion in the an-
nual final list under clause (i), the Sec-
retary shall— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(I) provide that, to the extent 
practicable, all quality domains (as 
defined in subsection (s)(1)(B)) are 
addressed by such measures; and 
‘‘(II) ensure that such selection 
is consistent with the process for se-
lection of measures under subsections 
(k), (m), and (p)(2). 
‘‘(iv) PEER REVIEW.—Before includ-
ing a new measure or a measure described 
in clause (i)(II)(cc) in the final list of 
measures published under clause (i) for a 
year, the Secretary shall submit for publi-
cation in applicable specialty-appropriate 
peer-reviewed journals such measure and 
the method for developing and selecting 
such measure, including clinical and other 
data supporting such measure. 
‘‘(v) MEASURES
FOR
INCLUSION.— 
The final list of quality measures published 
under clause (i) shall include, as applica-
ble, measures under subsections (k), (m), 
and (p)(2), including quality measures 
from among— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(I) measures endorsed by a con-
sensus-based entity; 
‘‘(II) measures developed under 
subsection (s); and 
‘‘(III) measures submitted under 
clause (ii)(I). 
Any measure selected for inclusion in such 
list that is not endorsed by a consensus- 
based entity shall have a focus that is evi-
dence-based. 
‘‘(vi) EXCEPTION
FOR
QUALIFIED 
CLINICAL
DATA
REGISTRY
MEASURES.— 
Measures used by a qualified clinical data 
registry under subsection (m)(3)(E) shall 
not be subject to the requirements under 
clauses (i), (iv), and (v). The Secretary 
shall publish the list of measures used by 
such qualified clinical data registries on 
the Internet website of the Centers for 
Medicare & Medicaid Services. 
‘‘(vii) 
EXCEPTION
FOR
EXISTING 
QUALITY
MEASURES.—Any quality meas-
ure specified by the Secretary under sub-
section (k) or (m), including under sub-
section (m)(3)(E), and any measure of 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
quality of care established under sub-
section (p)(2) for the reporting period 
under the respective subsection beginning 
before the first performance period under 
the MIPS— 
‘‘(I) shall not be subject to the 
requirements under clause (i) (except 
under items (aa) and (cc) of subclause 
(II) of such clause) or to the require-
ment under clause (iv); and 
‘‘(II) shall be included in the 
final list of quality measures pub-
lished under clause (i) unless removed 
under clause (i)(II)(aa). 
‘‘(viii) CONSULTATION
WITH
REL-
EVANT ELIGIBLE PROFESSIONAL ORGANI-
ZATIONS
AND
OTHER
RELEVANT
STAKE-
HOLDERS.—Relevant eligible professional 
organizations and other relevant stake-
holders, including State and national med-
ical societies, shall be consulted in carrying 
out this subparagraph. 
‘‘(ix) OPTIONAL
APPLICATION.—The 
process under section 1890A is not re-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
quired to apply to the selection of meas-
ures under this subparagraph. 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) ESTABLISHMENT.—Under the MIPS, 
the Secretary shall establish performance stand-
ards with respect to measures and activities 
specified under paragraph (2)(B) for a perform-
ance period (as established under paragraph 
(4)) for a year. 
‘‘(B) CONSIDERATIONS IN ESTABLISHING 
STANDARDS.—In establishing such performance 
standards with respect to measures and activi-
ties specified under paragraph (2)(B), the Sec-
retary shall consider the following: 
‘‘(i) Historical performance standards. 
‘‘(ii) Improvement. 
‘‘(iii) The opportunity for continued 
improvement. 
‘‘(4) PERFORMANCE
PERIOD.—The Secretary 
shall establish a performance period (or periods) for 
a year (beginning with the year described in para-
graph (1)(B)). Such performance period (or periods) 
shall begin and end prior to the beginning of such 
year and be as close as possible to such year. In this 
subsection, such performance period (or periods) for 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
a year shall be referred to as the performance period 
for the year. 
‘‘(5) COMPOSITE PERFORMANCE SCORE.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this paragraph and taking 
into account, as available and applicable, para-
graph (1)(G), the Secretary shall develop a 
methodology for assessing the total performance 
of each MIPS eligible professional according to 
performance standards under paragraph (3) 
with respect to applicable measures and activi-
ties specified in paragraph (2)(B) with respect 
to each performance category applicable to such 
professional for a performance period (as estab-
lished under paragraph (4)) for a year. Using 
such methodology, the Secretary shall provide 
for a composite assessment (using a scoring 
scale of 0 to 100) for each such professional for 
the performance period for such year. In this 
subsection such a composite assessment for 
such a professional with respect to a perform-
ance period shall be referred to as the ‘com-
posite performance score’ for such professional 
for such performance period. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(B) INCENTIVE
TO
REPORT; ENCOUR-
AGING USE OF CERTIFIED EHR TECHNOLOGY 
FOR REPORTING QUALITY MEASURES.— 
‘‘(i) INCENTIVE TO REPORT.—Under 
the methodology established under sub-
paragraph (A), the Secretary shall provide 
that in the case of a MIPS eligible profes-
sional who fails to report on an applicable 
measure or activity that is required to be 
reported by the professional, the profes-
sional shall be treated as achieving the 
lowest potential score applicable to such 
measure or activity. 
‘‘(ii) ENCOURAGING
USE
OF
CER-
TIFIED EHR TECHNOLOGY AND QUALIFIED 
CLINICAL DATA REGISTRIES FOR REPORT-
ING
QUALITY
MEASURES.—Under 
the 
methodology established under subpara-
graph (A), the Secretary shall— 
‘‘(I) encourage MIPS eligible 
professionals to report on applicable 
measures with respect to the perform-
ance category described in paragraph 
(2)(A)(i) through the use of certified 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
EHR technology and qualified clinical 
data registries; and 
‘‘(II) with respect to a perform-
ance period, with respect to a year, 
for which a MIPS eligible professional 
reports such measures through the 
use of such EHR technology, treat 
such professional as satisfying the 
clinical quality measures reporting re-
quirement described in subsection 
(o)(2)(A)(iii) for such year. 
‘‘(C) CLINICAL
PRACTICE
IMPROVEMENT 
ACTIVITIES PERFORMANCE SCORE.— 
‘‘(i) RULE
FOR
ACCREDITATION.—A 
MIPS eligible professional who is in a 
practice that is certified as a patient-cen-
tered medical home or comparable spe-
cialty practice pursuant to subsection 
(b)(8)(B)(i) with respect to a performance 
period shall be given the highest potential 
score for the performance category de-
scribed in paragraph (2)(A)(iii) for such 
period. 
‘‘(ii) APM PARTICIPATION.—Partici-
pation by a MIPS eligible professional in 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
an alternative payment model (as defined 
in section 1833(z)(3)(C)) with respect to a 
performance period shall earn such eligible 
professional a minimum score of one-half 
of the highest potential score for the per-
formance category described in paragraph 
(2)(A)(iii) for such performance period. 
‘‘(iii) SUBCATEGORIES.—A MIPS eli-
gible professional shall not be required to 
perform activities in each subcategory 
under paragraph (2)(B)(iii) or participate 
in an alternative payment model in order 
to achieve the highest potential score for 
the performance category described in 
paragraph (2)(A)(iii). 
‘‘(D) 
ACHIEVEMENT
AND
IMPROVE-
MENT.— 
‘‘(i) TAKING INTO ACCOUNT IMPROVE-
MENT.—Beginning with the second year to 
which the MIPS applies, in addition to the 
achievement of a MIPS eligible profes-
sional, if data sufficient to measure im-
provement is available, the methodology 
developed under subparagraph (A)— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00040
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(I) in the case of the perform-
ance score for the performance cat-
egory described in clauses (i) and (ii) 
of paragraph (2)(A), shall take into 
account the improvement of the pro-
fessional; and 
‘‘(II) in the case of performance 
scores for other performance cat-
egories, may take into account the im-
provement of the professional. 
‘‘(ii) ASSIGNING HIGHER WEIGHT FOR 
ACHIEVEMENT.—Beginning 
with 
the 
fourth year to which the MIPS applies, 
under the methodology developed under 
subparagraph (A), the Secretary may as-
sign a higher scoring weight under sub-
paragraph (F) with respect to the achieve-
ment of a MIPS eligible professional than 
with respect to any improvement of such 
professional applied under clause (i) with 
respect to a measure, activity, or category 
described in paragraph (2). 
‘‘(E) WEIGHTS
FOR
THE
PERFORMANCE 
CATEGORIES.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(i) IN GENERAL.—Under the meth-
odology developed under subparagraph (A), 
subject to subparagraph (F)(i) and clauses 
(ii) and (iii), the composite performance 
score shall be determined as follows: 
‘‘(I) QUALITY.— 
‘‘(aa) IN
GENERAL.—Sub-
ject to item (bb), thirty percent 
of such score shall be based on 
performance with respect to the 
category described in clause (i) of 
paragraph (2)(A). In applying 
the previous sentence, the Sec-
retary shall, as feasible, encour-
age the application of outcome 
measures within such category. 
‘‘(bb) FIRST 2 YEARS.—For 
the first and second years for 
which the MIPS applies to pay-
ments, the percentage applicable 
under item (aa) shall be in-
creased in a manner such that 
the total percentage points of the 
increase under this item for the 
respective year equals the total 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00042
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
number of percentage points by 
which the percentage applied 
under subclause (II)(bb) for the 
respective year is less than 30 
percent. 
‘‘(II) RESOURCE USE.— 
‘‘(aa) IN
GENERAL.—Sub-
ject to item (bb), thirty percent 
of such score shall be based on 
performance with respect to the 
category described in clause (ii) 
of paragraph (2)(A). 
‘‘(bb) FIRST 2 YEARS.—For 
the first year for which the MIPS 
applies to payments, not more 
than 10 percent of such score 
shall be based on performance 
with respect to the category de-
scribed in clause (ii) of para-
graph (2)(A). For the second 
year for which the MIPS applies 
to payments, not more than 15 
percent of such score shall be 
based on performance with re-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00043
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
spect to the category described in 
clause (ii) of paragraph (2)(A). 
‘‘(III) CLINICAL
PRACTICE
IM-
PROVEMENT
ACTIVITIES.—Fifteen 
percent of such score shall be based 
on performance with respect to the 
category described in clause (iii) of 
paragraph (2)(A). 
‘‘(IV) MEANINGFUL USE OF CER-
TIFIED
EHR
TECHNOLOGY.—Twenty- 
five percent of such score shall be 
based on performance with respect to 
the category described in clause (iv) of 
paragraph (2)(A). 
‘‘(ii) AUTHORITY
TO
ADJUST
PER-
CENTAGES IN CASE OF HIGH EHR MEAN-
INGFUL USE ADOPTION.—In any year in 
which the Secretary estimates that the pro-
portion of eligible professionals (as defined 
in subsection (o)(5)) who are meaningful 
EHR users (as determined under sub-
section (o)(2)) is 75 percent or greater, the 
Secretary may reduce the percent applica-
ble under clause (i)(IV), but not below 15 
percent. If the Secretary makes such re-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00044
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
duction for a year, subject to subclauses 
(I)(bb) and (II)(bb) of clause (i), the per-
centages applicable under one or more of 
subclauses (I), (II), and (III) of clause (i) 
for such year shall be increased in a man-
ner such that the total percentage points 
of the increase under this clause for such 
year equals the total number of percentage 
points reduced under the preceding sen-
tence for such year. 
‘‘(F) 
CERTAIN
FLEXIBILITY
FOR 
WEIGHTING PERFORMANCE CATEGORIES, MEAS-
URES, AND
ACTIVITIES.—Under the method-
ology under subparagraph (A), if there are not 
sufficient measures and clinical practice im-
provement activities applicable and available to 
each type of eligible professional involved, the 
Secretary shall assign different scoring weights 
(including a weight of 0)— 
‘‘(i) which may vary from the scoring 
weights specified in subparagraph (E), for 
each performance category based on the 
extent to which the category is applicable 
to the type of eligible professional involved; 
and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00045
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(ii) for each measure and activity 
specified under paragraph (2)(B) with re-
spect to each such category based on the 
extent to which the measure or activity is 
applicable and available to the type of eli-
gible professional involved. 
‘‘(G) RESOURCE
USE.—Analysis of the 
performance category described in paragraph 
(2)(A)(ii) shall include results from the method-
ology described in subsection (r)(5), as appro-
priate. 
‘‘(H) INCLUSION
OF
QUALITY
MEASURE 
DATA FROM OTHER PAYERS.—In applying sub-
sections (k), (m), and (p) with respect to meas-
ures described in paragraph (2)(B)(i), analysis 
of the performance category described in para-
graph (2)(A)(i) may include data submitted by 
MIPS eligible professionals with respect to 
items and services furnished to individuals who 
are not individuals entitled to benefits under 
part A or enrolled under part B. 
‘‘(I) USE OF VOLUNTARY VIRTUAL GROUPS 
FOR CERTAIN ASSESSMENT PURPOSES.— 
‘‘(i) IN
GENERAL.—In the case of 
MIPS eligible professionals electing to be a 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00046
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
virtual group under clause (ii) with respect 
to a performance period for a year, for 
purposes of applying the methodology 
under subparagraph (A)— 
‘‘(I) the assessment of perform-
ance provided under such methodology 
with respect to the performance cat-
egories described in clauses (i) and 
(ii) of paragraph (2)(A) that is to be 
applied to each such professional in 
such group for such performance pe-
riod shall be with respect to the com-
bined performance of all such profes-
sionals in such group for such period; 
and 
‘‘(II) the composite score pro-
vided under this paragraph for such 
performance period with respect to 
each such performance category for 
each such MIPS eligible professional 
in such virtual group shall be based 
on the assessment of the combined 
performance under subclause (I) for 
the performance category and per-
formance period. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00047
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(ii) ELECTION OF PRACTICES TO BE 
A VIRTUAL GROUP.—The Secretary shall, 
in accordance with clause (iii), establish 
and have in place a process to allow an in-
dividual MIPS eligible professional or a 
group practice consisting of not more than 
10 MIPS eligible professionals to elect, 
with respect to a performance period for a 
year, for such individual MIPS eligible pro-
fessional or all such MIPS eligible profes-
sionals in such group practice, respectively, 
to be a virtual group under this subpara-
graph with at least one other such indi-
vidual MIPS eligible professional or group 
practice making such an election. Such a 
virtual group may be based on geographic 
areas or on provider specialties defined by 
nationally recognized multispecialty boards 
of certification or equivalent certification 
boards and such other eligible professional 
groupings in order to capture classifica-
tions of providers across eligible profes-
sional organizations and other practice 
areas or categories. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00048
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(iii) REQUIREMENTS.—The process 
under clause (ii)— 
‘‘(I) shall provide that an election 
under such clause, with respect to a 
performance period, shall be made be-
fore or during the beginning of such 
performance period and may not be 
changed during such performance pe-
riod; 
‘‘(II) shall provide that a practice 
described in such clause, and each 
MIPS eligible professional in such 
practice, may elect to be in no more 
than one virtual group for a perform-
ance period; and 
‘‘(III) may provide that a virtual 
group may be combined at the tax 
identification number level. 
‘‘(6) MIPS PAYMENTS.— 
‘‘(A) MIPS ADJUSTMENT FACTOR.—Tak-
ing into account paragraph (1)(G), the Sec-
retary shall specify a MIPS adjustment factor 
for each MIPS eligible professional for a year. 
Such MIPS adjustment factor for a MIPS eligi-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00049
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
ble professional for a year shall be in the form 
of a percent and shall be determined— 
‘‘(i) by comparing the composite per-
formance score of the eligible professional 
for such year to the performance threshold 
established under subparagraph (D)(i) for 
such year; 
‘‘(ii) in a manner such that the ad-
justment factors specified under this sub-
paragraph for a year result in differential 
payments under this paragraph reflecting 
that— 
‘‘(I) MIPS eligible professionals 
with composite performance scores for 
such year at or above such perform-
ance threshold for such year receive 
zero or positive incentive payment ad-
justment factors for such year in ac-
cordance with clause (iii), with such 
professionals having higher composite 
performance scores receiving higher 
adjustment factors; and 
‘‘(II) MIPS eligible professionals 
with composite performance scores for 
such year below such performance 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00050
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
threshold for such year receive nega-
tive payment adjustment factors for 
such year in accordance with clause 
(iv), with such professionals having 
lower composite performance scores 
receiving lower adjustment factors; 
‘‘(iii) in a manner such that MIPS eli-
gible professionals with composite scores 
described in clause (ii)(I) for such year, 
subject to clauses (i) and (ii) of subpara-
graph (F), receive a zero or positive ad-
justment factor on a linear sliding scale 
such that an adjustment factor of 0 per-
cent is assigned for a score at the perform-
ance threshold and an adjustment factor of 
the applicable percent specified in subpara-
graph (B) is assigned for a score of 100; 
and 
‘‘(iv) in a manner such that— 
‘‘(I) subject to subclause (II), 
MIPS eligible professionals with com-
posite performance scores described in 
clause (ii)(II) for such year receive a 
negative payment adjustment factor 
on a linear sliding scale such that an 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(C) ADDITIONAL MIPS ADJUSTMENT FAC-
TORS FOR EXCEPTIONAL PERFORMANCE.— 
‘‘(i) IN GENERAL.—In the case of a 
MIPS eligible professional with a com-
posite performance score for a year at or 
above the additional performance threshold 
under subparagraph (D)(ii) for such year, 
in addition to the MIPS adjustment factor 
under subparagraph (A) for the eligible 
professional for such year, subject to the 
availability of funds under clause (ii), the 
Secretary shall specify an additional posi-
tive MIPS adjustment factor for such pro-
fessional and year. Such additional MIPS 
adjustment factors shall be determined by 
the Secretary in a manner such that pro-
fessionals having higher composite per-
formance scores above the additional per-
formance threshold receive higher addi-
tional MIPS adjustment factors. 
‘‘(ii) ADDITIONAL FUNDING POOL.— 
For 2018 and each subsequent year 
through 2023, there is appropriated from 
the Federal Supplementary Medical Insur-
ance Trust Fund $500,000,000 for MIPS 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
payments under this paragraph resulting 
from the application of the additional 
MIPS adjustment factors under clause (i). 
‘‘(D) ESTABLISHMENT OF PERFORMANCE 
THRESHOLDS.— 
‘‘(i) PERFORMANCE
THRESHOLD.— 
For each year of the MIPS, the Secretary 
shall compute a performance threshold 
with respect to which the composite per-
formance score of MIPS eligible profes-
sionals shall be compared for purposes of 
determining adjustment factors under sub-
paragraph (A) that are positive, negative, 
and zero. Such performance threshold for 
a year shall be the mean or median (as se-
lected by the Secretary) of the composite 
performance scores for all MIPS eligible 
professionals with respect to a prior period 
specified by the Secretary. The Secretary 
may reassess the selection under the pre-
vious sentence every 3 years. 
‘‘(ii) 
ADDITIONAL
PERFORMANCE 
THRESHOLD FOR EXCEPTIONAL PERFORM-
ANCE.—In addition to the performance 
threshold under clause (i), for each year of 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
the MIPS, the Secretary shall compute an 
additional performance threshold for pur-
poses of determining the additional MIPS 
adjustment factors under subparagraph 
(C)(i). For each such year, the Secretary 
shall apply either of the following methods 
for computing such additional performance 
threshold for such a year: 
‘‘(I) The threshold shall be the 
score that is equal to the 25th per-
centile of the range of possible com-
posite performance scores above the 
performance threshold with respect to 
the prior period described in clause 
(i). 
‘‘(II) The threshold shall be the 
score that is equal to the 25th per-
centile of the actual composite per-
formance scores for MIPS eligible 
professionals with composite perform-
ance scores at or above the perform-
ance threshold with respect to the 
prior period described in clause (i). 
‘‘(iii) SPECIAL RULE FOR INITIAL 2 
YEARS.—With respect to each of the first 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
two years to which the MIPS applies, the 
Secretary shall, prior to the performance 
period for such years, establish a perform-
ance threshold for purposes of determining 
MIPS adjustment factors under subpara-
graph (A) and a threshold for purposes of 
determining additional MIPS adjustment 
factors under subparagraph (C)(i). Each 
such performance threshold shall— 
‘‘(I) be based on a period prior to 
such performance periods; and 
‘‘(II) take into account— 
‘‘(aa) data available with re-
spect to performance on meas-
ures and activities that may be 
used under the performance cat-
egories 
under 
subparagraph 
(2)(B); and 
‘‘(bb) other factors deter-
mined appropriate by the Sec-
retary. 
‘‘(E) APPLICATION OF MIPS ADJUSTMENT 
FACTORS.—In the case of items and services 
furnished by a MIPS eligible professional dur-
ing a year (beginning with 2018), the amount 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00056
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
otherwise paid under this part with respect to 
such items and services and MIPS eligible pro-
fessional for such year, shall be multiplied by— 
‘‘(i) 1, plus 
‘‘(ii) the sum of— 
‘‘(I) the MIPS adjustment factor 
determined under subparagraph (A) 
divided by 100, and 
‘‘(II) as applicable, the additional 
MIPS adjustment factor determined 
under subparagraph (C)(i) divided by 
100. 
‘‘(F) AGGREGATE
APPLICATION
OF
MIPS 
ADJUSTMENT FACTORS.— 
‘‘(i) APPLICATION OF SCALING FAC-
TOR.— 
‘‘(I) IN GENERAL.—With respect 
to positive MIPS adjustment factors 
under subparagraph (A)(ii)(I) for eli-
gible professionals whose composite 
performance score is above the per-
formance threshold under subpara-
graph (D)(i) for such year, subject to 
subclause (II), the Secretary shall in-
crease or decrease such adjustment 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00057
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
factors by a scaling factor in order to 
ensure that the budget neutrality re-
quirement of clause (ii) is met. 
‘‘(II) SCALING FACTOR LIMIT.— 
In no case may be the scaling factor 
applied under this clause exceed 3.0. 
‘‘(ii) BUDGET NEUTRALITY REQUIRE-
MENT.— 
‘‘(I) IN
GENERAL.—Subject to 
clause (iii), the Secretary shall ensure 
that the estimated amount described 
in subclause (II) for a year is equal to 
the estimated amount described in 
subclause (III) for such year. 
‘‘(II) AGGREGATE INCREASES.— 
The amount described in this sub-
clause is the estimated increase in the 
aggregate allowed charges resulting 
from the application of positive MIPS 
adjustment factors under subpara-
graph (A) (after application of the 
scaling factor described in clause (i)) 
to MIPS eligible professionals whose 
composite performance score for a 
year is above the performance thresh-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00058
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
old under subparagraph (D)(i) for 
such year. 
‘‘(III) 
AGGREGATE
DE-
CREASES.—The amount described in 
this subclause is the estimated de-
crease 
in 
the 
aggregate 
allowed 
charges resulting from the application 
of negative MIPS adjustment factors 
under subparagraph (A) to MIPS eli-
gible professionals whose composite 
performance score for a year is below 
the performance threshold under sub-
paragraph (D)(i) for such year. 
‘‘(iii) EXCEPTIONS.— 
‘‘(I) In the case that all MIPS el-
igible professionals receive composite 
performance scores for a year that are 
below 
the 
performance 
threshold 
under subparagraph (D)(i) for such 
year, the negative MIPS adjustment 
factors under subparagraph (A) shall 
apply with respect to such MIPS eligi-
ble professionals and the budget neu-
trality requirement of clause (ii) shall 
not apply for such year. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00059
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(II) In the case that, with re-
spect to a year, the application of 
clause (i) results in a scaling factor 
equal to the maximum scaling factor 
specified in clause (i)(II), such scaling 
factor shall apply and the budget neu-
trality requirement of clause (ii) shall 
not apply for such year. 
‘‘(iv) ADDITIONAL
INCENTIVE
PAY-
MENT
ADJUSTMENTS.—In specifying the 
MIPS additional adjustment factors under 
subparagraph (C)(i) for each applicable 
MIPS eligible professional for a year, the 
Secretary shall ensure that the estimated 
increase in payments under this part re-
sulting from the application of such addi-
tional adjustment factors for MIPS eligible 
professionals in a year shall be equal (as 
estimated by the Secretary) to the addi-
tional funding pool amount for such year 
under subparagraph (C)(ii). 
‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUST-
MENTS.—Under the MIPS, the Secretary shall, not 
later than 30 days prior to January 1 of the year 
involved, make available to MIPS eligible profes-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00060
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
sionals the MIPS adjustment factor (and, as appli-
cable, the additional MIPS adjustment factor) under 
paragraph (6) applicable to the eligible professional 
for items and services furnished by the professional 
for such year. The Secretary may include such infor-
mation in the confidential feedback under paragraph 
(12). 
‘‘(8) NO EFFECT IN SUBSEQUENT YEARS.—The 
MIPS adjustment factors and additional MIPS ad-
justment factors under paragraph (6) shall apply 
only with respect to the year involved, and the Sec-
retary shall not take into account such adjustment 
factors in making payments to a MIPS eligible pro-
fessional under this part in a subsequent year. 
‘‘(9) PUBLIC REPORTING.— 
‘‘(A) IN GENERAL.—The Secretary shall, 
in an easily understandable format, make avail-
able on the Physician Compare Internet website 
of the Centers for Medicare & Medicaid Serv-
ices the following: 
‘‘(i) Information regarding the per-
formance of MIPS eligible professionals 
under the MIPS, which— 
‘‘(I) shall include the composite 
score for each such MIPS eligible pro-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00061
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
fessional and the performance of each 
such MIPS eligible professional with 
respect to each performance category; 
and 
‘‘(II) may include the perform-
ance of each such MIPS eligible pro-
fessional with respect to each measure 
or activity specified in paragraph 
(2)(B). 
‘‘(ii) The names of eligible profes-
sionals in eligible alternative payment mod-
els (as defined in section 1833(z)(3)(D)) 
and, to the extent feasible, the names of 
such eligible alternative payment models 
and performance of such models. 
‘‘(B) 
DISCLOSURE.—The 
information 
made available under this paragraph shall indi-
cate, where appropriate, that publicized infor-
mation may not be representative of the eligible 
professional’s entire patient population, the va-
riety of services furnished by the eligible profes-
sional, or the health conditions of individuals 
treated. 
‘‘(C) OPPORTUNITY TO REVIEW AND SUB-
MIT
CORRECTIONS.—The Secretary shall pro-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
vide for an opportunity for a professional de-
scribed in subparagraph (A) to review, and sub-
mit corrections for, the information to be made 
public with respect to the professional under 
such subparagraph prior to such information 
being made public. 
‘‘(D) 
AGGREGATE
INFORMATION.—The 
Secretary shall periodically post on the Physi-
cian Compare Internet website aggregate infor-
mation on the MIPS, including the range of 
composite scores for all MIPS eligible profes-
sionals and the range of the performance of all 
MIPS eligible professionals with respect to each 
performance category. 
‘‘(10) CONSULTATION.—The Secretary shall 
consult with stakeholders in carrying out the MIPS, 
including for the identification of measures and ac-
tivities under paragraph (2)(B) and the methodolo-
gies developed under paragraphs (5)(A) and (6) and 
regarding the use of qualified clinical data registries. 
Such consultation shall include the use of a request 
for information or other mechanisms determined ap-
propriate. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(11) TECHNICAL ASSISTANCE TO SMALL PRAC-
TICES AND PRACTICES IN HEALTH PROFESSIONAL 
SHORTAGE AREAS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
enter into contracts or agreements with appro-
priate entities (such as quality improvement or-
ganizations, regional extension centers (as de-
scribed in section 3012(c) of the Public Health 
Service Act), or regional health collaboratives) 
to offer guidance and assistance to MIPS eligi-
ble professionals in practices of 15 or fewer pro-
fessionals (with priority given to such practices 
located in rural areas, health professional short-
age areas (as designated under in section 
332(a)(1)(A) of such Act), and medically under-
served areas, and practices with low composite 
scores) with respect to— 
‘‘(i) the performance categories de-
scribed in clauses (i) through (iv) of para-
graph (2)(A); or 
‘‘(ii) how to transition to the imple-
mentation of and participation in an alter-
native payment model as described in sec-
tion 1833(z)(3)(C). 
‘‘(B) FUNDING FOR IMPLEMENTATION.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(i) IN
GENERAL.—For purposes of 
implementing subparagraph (A), the Sec-
retary shall provide for the transfer from 
the Federal Supplementary Medical Insur-
ance Trust Fund established under section 
1841 to the Centers for Medicare & Med-
icaid Services Program Management Ac-
count of $40,000,000 for each of fiscal 
years 2015 through 2019. Amounts trans-
ferred under this subparagraph for a fiscal 
year shall be available until expended. 
‘‘(ii) 
TECHNICAL
ASSISTANCE.—Of 
the amounts transferred pursuant to clause 
(i) for each of fiscal years 2015 through 
2019, not less than $10,000,000 shall be 
made available for each such year for tech-
nical assistance to small practices in health 
professional shortage areas (as so des-
ignated) and medically underserved areas. 
‘‘(12) FEEDBACK
AND
INFORMATION
TO
IM-
PROVE PERFORMANCE.— 
‘‘(A) PERFORMANCE FEEDBACK.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2016, the Secretary— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00065
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
and (m)), be provided based on perform-
ance on quality measures reported through 
the use of such registries. With respect to 
any other performance category described 
in paragraph (2)(A), the Secretary shall 
encourage provision of feedback through 
qualified clinical data registries as de-
scribed in subsection (m)(3)(E)). 
‘‘(iii) USE OF DATA.—For purposes of 
clause (i), the Secretary may use data, 
with respect to a MIPS eligible profes-
sional, from periods prior to the current 
performance period and may use rolling 
periods in order to make illustrative cal-
culations about the performance of such 
professional. 
‘‘(iv) 
DISCLOSURE
EXEMPTION.— 
Feedback made available under this sub-
paragraph shall be exempt from disclosure 
under section 552 of title 5, United States 
Code. 
‘‘(v) RECEIPT
OF
INFORMATION.— 
The Secretary may use the mechanisms es-
tablished under clause (ii) to receive infor-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00067
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
mation from professionals, such as infor-
mation with respect to this subsection. 
‘‘(B) ADDITIONAL INFORMATION.— 
‘‘(i) IN GENERAL.—Beginning July 1, 
2017, the Secretary shall make available to 
each MIPS eligible professional informa-
tion, with respect to individuals who are 
patients of such MIPS eligible professional, 
about items and services for which pay-
ment is made under this title that are fur-
nished to such individuals by other sup-
pliers and providers of services, which may 
include information described in clause (ii). 
Such information may be made available 
under the previous sentence to such MIPS 
eligible professionals by mechanisms deter-
mined appropriate by the Secretary, which 
may include use of a web-based portal. 
Such information may be made available in 
accordance with the same or similar terms 
as data are made available to accountable 
care organizations participating in the 
shared savings program under section 
1899, including a beneficiary opt-out. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00068
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(ii) TYPE
OF
INFORMATION.—For 
purposes of clause (i), the information de-
scribed in this clause, is the following: 
‘‘(I) With respect to selected 
items and services (as determined ap-
propriate by the Secretary) for which 
payment is made under this title and 
that are furnished to individuals, who 
are patients of a MIPS eligible profes-
sional, by another supplier or provider 
of services during the most recent pe-
riod for which data are available (such 
as the most recent three-month pe-
riod), such as the name of such pro-
viders furnishing such items and serv-
ices to such patients during such pe-
riod, the types of such items and serv-
ices so furnished, and the dates such 
items and services were so furnished. 
‘‘(II) Historical data, such as 
averages and other measures of the 
distribution if appropriate, of the 
total, and components of, allowed 
charges (and other figures as deter-
mined appropriate by the Secretary). 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00069
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(13) REVIEW.— 
‘‘(A) TARGETED REVIEW.—The Secretary 
shall establish a process under which a MIPS 
eligible professional may seek an informal re-
view of the calculation of the MIPS adjustment 
factor applicable to such eligible professional 
under this subsection for a year. The results of 
a review conducted pursuant to the previous 
sentence shall not be taken into account for 
purposes of paragraph (6) with respect to a 
year (other than with respect to the calculation 
of such eligible professional’s MIPS adjustment 
factor for such year or additional MIPS adjust-
ment factor for such year) after the factors de-
termined in subparagraph (A) and subpara-
graph (C) of such paragraph have been deter-
mined for such year. 
‘‘(B) LIMITATION.—Except as provided for 
in subparagraph (A), there shall be no adminis-
trative or judicial review under section 1869, 
section 1878, or otherwise of the following: 
‘‘(i) The methodology used to deter-
mine the amount of the MIPS adjustment 
factor under paragraph (6)(A) and the 
amount of the additional MIPS adjustment 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00070
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
factor under paragraph (6)(C)(i) and the 
determination of such amounts. 
‘‘(ii) The establishment of the per-
formance standards under paragraph (3) 
and the performance period under para-
graph (4). 
‘‘(iii) The identification of measures 
and activities specified under paragraph 
(2)(B) and information made public or 
posted on the Physician Compare Internet 
website of the Centers for Medicare & 
Medicaid Services under paragraph (9). 
‘‘(iv) 
The 
methodology 
developed 
under paragraph (5) that is used to cal-
culate performance scores and the calcula-
tion of such scores, including the weighting 
of measures and activities under such 
methodology.’’. 
(2) GAO REPORTS.— 
(A) EVALUATION
OF
ELIGIBLE
PROFES-
SIONAL MIPS.—Not later than October 1, 2019, 
and October 1, 2022, the Comptroller General 
of the United States shall submit to Congress 
a report evaluating the eligible professional 
Merit-based Incentive Payment System under 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00071
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
subsection (q) of section 1848 of the Social Se-
curity Act (42 U.S.C. 1395w–4), as added by 
paragraph (1). Such report shall— 
(i) examine the distribution of the 
composite performance scores and MIPS 
adjustment factors (and additional MIPS 
adjustment factors) for MIPS eligible pro-
fessionals 
(as 
defined 
in 
subsection 
(q)(1)(c) of such section) under such pro-
gram, and patterns relating to such scores 
and adjustment factors, including based on 
type of provider, practice size, geographic 
location, and patient mix; 
(ii) provide recommendations for im-
proving such program; 
(iii) evaluate the impact of technical 
assistance 
funding 
under 
section 
1848(q)(11) of the Social Security Act, as 
added by paragraph (1), on the ability of 
professionals to improve within such pro-
gram or successfully transition to an alter-
native payment model (as defined in sec-
tion 1833(z)(3) of the Social Security Act, 
as added by subsection (e)), with priority 
for such evaluation given to practices lo-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00072
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
cated in rural areas, health professional 
shortage areas (as designated in section 
332(a)(1)(a) of the Public Health Service 
Act), and medically underserved areas; and 
(iv) provide recommendations for opti-
mizing the use of such technical assistance 
funds. 
(B) STUDY TO EXAMINE ALIGNMENT OF 
QUALITY MEASURES USED IN PUBLIC AND PRI-
VATE PROGRAMS.— 
(i) IN GENERAL.—Not later than 18 
months after the date of the enactment of 
this Act, the Comptroller General of the 
United States shall submit to Congress a 
report that— 
(I) compares the similarities and 
differences in the use of quality meas-
ures under the original Medicare fee- 
for-service program under parts A and 
B of title XVIII of the Social Security 
Act, the Medicare Advantage program 
under part C of such title, selected 
State Medicaid programs under title 
XIX of such Act, and private payer 
arrangements; and 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00073
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(II) makes recommendations on 
how to reduce the administrative bur-
den involved in applying such quality 
measures. 
(ii) 
REQUIREMENTS.—The 
report 
under clause (i) shall— 
(I) consider those measures ap-
plicable to individuals entitled to, or 
enrolled for, benefits under such part 
A, or enrolled under such part B and 
individuals under the age of 65; and 
(II) focus on those measures that 
comprise the most significant compo-
nent of the quality performance cat-
egory of the eligible professional 
MIPS incentive program under sub-
section (q) of section 1848 of the So-
cial Security Act (42 U.S.C. 1395w– 
4), as added by paragraph (1). 
(C) STUDY
ON
ROLE
OF
INDEPENDENT 
RISK MANAGERS.—Not later than January 1, 
2016, the Comptroller General of the United 
States shall submit to Congress a report exam-
ining whether entities that pool financial risk 
for physician practices, such as independent 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00074
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
risk managers, can play a role in supporting 
physician practices, particularly small physician 
practices, in assuming financial risk for the 
treatment of patients. Such report shall exam-
ine barriers that small physician practices cur-
rently face in assuming financial risk for treat-
ing patients, the types of risk management enti-
ties that could assist physician practices in par-
ticipating in two-sided risk payment models, 
and how such entities could assist with risk 
management and with quality improvement ac-
tivities. Such report shall also include an anal-
ysis of any existing legal barriers to such ar-
rangements. 
(D) STUDY
TO
EXAMINE
RURAL
AND 
HEALTH
PROFESSIONAL
SHORTAGE
AREA
AL-
TERNATIVE PAYMENT MODELS.—Not later than 
October 1, 2020, and October 1, 2022, the 
Comptroller General of the United States shall 
submit to Congress a report that examines the 
transition of professionals in rural areas, health 
professional shortage areas (as designated in 
section 332(a)(1)(A) of the Public Health Serv-
ice Act), or medically underserved areas to an 
alternative payment model (as defined in sec-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00075
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
tion 1833(z)(3) of the Social Security Act, as 
added by subsection (e)). Such report shall 
make recommendations for removing adminis-
trative barriers to practices, including small 
practices consisting of 15 or fewer profes-
sionals, in rural areas, health professional 
shortage areas, and medically underserved areas 
to participation in such models. 
(3) FUNDING
FOR
IMPLEMENTATION.—For 
purposes of implementing the provisions of and the 
amendments made by this section, the Secretary of 
Health and Human Services shall provide for the 
transfer of $80,000,000 from the Supplementary 
Medical Insurance Trust Fund established under 
section 1841 of the Social Security Act (42 U.S.C. 
1395t) to the Centers for Medicare & Medicaid Pro-
gram Management Account for each of the fiscal 
years 2014 through 2018. Amounts transferred 
under this paragraph shall be available until ex-
pended. 
(d) IMPROVING QUALITY REPORTING
FOR COM-
POSITE SCORES.— 
(1) CHANGES
FOR
GROUP
REPORTING
OP-
TION.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00076
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(A) 
IN
GENERAL.—Section 
1848(m)(3)(C)(ii)) of the Social Security Act 
(42 U.S.C. 1395w–4(m)(3)(C)(ii)) is amended 
by inserting ‘‘and, for 2015 and subsequent 
years, may provide’’ after ‘‘shall provide’’. 
(B) CLARIFICATION OF QUALIFIED CLIN-
ICAL
DATA
REGISTRY
REPORTING
TO
GROUP 
PRACTICES.—Section 1848(m)(3)(D) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(m)(3)(D)) is amended by inserting ‘‘and, for 
2015 and subsequent years, subparagraph (A) 
or (C)’’ after ‘‘subparagraph (A)’’. 
(2) CHANGES FOR MULTIPLE REPORTING PERI-
ODS
AND
ALTERNATIVE
CRITERIA
FOR
SATISFAC-
TORY
REPORTING.—Section 1848(m)(5)(F) of the 
Social Security Act (42 U.S.C. 1395w–4(m)(5)(F)) 
is amended— 
(A) by striking ‘‘and subsequent years’’ 
and inserting ‘‘through reporting periods occur-
ring in 2014’’; and 
(B) by inserting ‘‘and, for reporting peri-
ods occurring in 2015 and subsequent years, 
the Secretary may establish’’ following ‘‘shall 
establish’’. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00077
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
(3) PHYSICIAN FEEDBACK PROGRAM REPORTS 
SUCCEEDED
BY
REPORTS
UNDER
MIPS.—Section 
1848(n) of the Social Security Act (42 U.S.C. 
1395w–4(n)) is amended by adding at the end the 
following new paragraph: 
‘‘(11) REPORTS ENDING WITH 2016.—Reports 
under the Program shall not be provided after De-
cember 31, 2016. See subsection (q)(12) for reports 
under the eligible professionals Merit-based Incentive 
Payment System.’’. 
(4) COORDINATION WITH SATISFYING MEANING-
FUL EHR USE CLINICAL QUALITY MEASURE REPORT-
ING
REQUIREMENT.—Section 1848(o)(2)(A)(iii) of 
the Social Security Act (42 U.S.C. 1395w– 
4(o)(2)(A)(iii)) is amended by inserting ‘‘and sub-
section (q)(5)(B)(ii)(II)’’ after ‘‘Subject to subpara-
graph (B)(ii)’’. 
(e) PROMOTING ALTERNATIVE PAYMENT MODELS.— 
(1) INCREASING TRANSPARENCY OF PHYSICIAN 
FOCUSED PAYMENT MODELS.—Section 1868 of the 
Social Security Act (42 U.S.C. 1395ee) is amended 
by adding at the end the following new subsection: 
‘‘(c) PHYSICIAN FOCUSED PAYMENT MODELS.— 
‘‘(1) TECHNICAL ADVISORY COMMITTEE.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00078
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(A) ESTABLISHMENT.—There is estab-
lished an ad hoc committee to be known as the 
‘Payment Model Technical Advisory Committee’ 
(referred to in this subsection as the ‘Com-
mittee’). 
‘‘(B) MEMBERSHIP.— 
‘‘(i) NUMBER
AND
APPOINTMENT.— 
The Committee shall be composed of 11 
members appointed by the Comptroller 
General of the United States. 
‘‘(ii) QUALIFICATIONS.—The member-
ship of the Committee shall include indi-
viduals with national recognition for their 
expertise in payment models and related 
delivery of care. No more than 5 members 
of the Committee shall be providers of 
services or suppliers, or representatives of 
providers of services or suppliers. 
‘‘(iii) PROHIBITION ON FEDERAL EM-
PLOYMENT.—A member of the Committee 
shall not be an employee of the Federal 
Government. 
‘‘(iv) 
ETHICS
DISCLOSURE.—The 
Comptroller General shall establish a sys-
tem for public disclosure by members of 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00079
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
the Committee of financial and other po-
tential conflicts of interest relating to such 
members. Members of the Committee shall 
be treated as employees of Congress for 
purposes of applying title I of the Ethics 
in Government Act of 1978 (Public Law 
95–521). 
‘‘(v) DATE
OF
INITIAL
APPOINT-
MENTS.—The initial appointments of mem-
bers of the Committee shall be made by 
not later than 180 days after the date of 
enactment of this subsection. 
‘‘(C) TERM; VACANCIES.— 
‘‘(i) TERM.—The terms of members of 
the Committee shall be for 3 years except 
that the Comptroller General shall des-
ignate staggered terms for the members 
first appointed. 
‘‘(ii) VACANCIES.—Any member ap-
pointed to fill a vacancy occurring before 
the expiration of the term for which the 
member’s predecessor was appointed shall 
be appointed only for the remainder of that 
term. A member may serve after the expi-
ration of that member’s term until a suc-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00080
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
cessor has taken office. A vacancy in the 
Committee shall be filled in the manner in 
which the original appointment was made. 
‘‘(D) DUTIES.—The Committee shall meet, 
as needed, to provide comments and rec-
ommendations to the Secretary, as described in 
paragraph (2)(C), on physician-focused pay-
ment models. 
‘‘(E) COMPENSATION OF MEMBERS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a member of the Com-
mittee shall serve without compensation. 
‘‘(ii) TRAVEL EXPENSES.—A member 
of the Committee shall be allowed travel 
expenses, including per diem in lieu of sub-
sistence, at rates authorized for an em-
ployee of an agency under subchapter I of 
chapter 57 of title 5, United States Code, 
while away from the home or regular place 
of business of the member in the perform-
ance of the duties of the Committee. 
‘‘(F) OPERATIONAL AND TECHNICAL SUP-
PORT.— 
‘‘(i) IN
GENERAL.—The Assistant 
Secretary for Planning and Evaluation 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00081
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
shall provide technical and operational sup-
port for the Committee, which may be by 
use of a contractor. The Office of the Ac-
tuary of the Centers for Medicare & Med-
icaid Services shall provide to the Com-
mittee actuarial assistance as needed. 
‘‘(ii) FUNDING.—The Secretary shall 
provide for the transfer, from the Federal 
Supplementary Medical Insurance Trust 
Fund under section 1841, such amounts as 
are necessary to carry out clause (i) (not 
to exceed $5,000,000) for fiscal year 2014 
and each subsequent fiscal year. Any 
amounts transferred under the preceding 
sentence for a fiscal year shall remain 
available until expended. 
‘‘(G) APPLICATION.—Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply to the Committee. 
‘‘(2) CRITERIA AND PROCESS FOR SUBMISSION 
AND
REVIEW
OF
PHYSICIAN-FOCUSED
PAYMENT 
MODELS.— 
‘‘(A) CRITERIA FOR ASSESSING PHYSICIAN- 
FOCUSED PAYMENT MODELS.— 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00082
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
‘‘(i) RULEMAKING.—Not later than 
November 1, 2015, the Secretary shall, 
through notice and comment rulemaking, 
following a request for information, estab-
lish criteria for physician-focused payment 
models, including models for specialist phy-
sicians, that could be used by the Com-
mittee for making comments and rec-
ommendations 
pursuant 
to 
paragraph 
(1)(D). 
‘‘(ii) MEDPAC SUBMISSION OF COM-
MENTS.—During the comment period for 
the proposed rule described in clause (i), 
the Medicare Payment Advisory Commis-
sion may submit comments to the Sec-
retary on the proposed criteria under such 
clause. 
‘‘(iii) UPDATING.—The Secretary may 
update the criteria established under this 
subparagraph through rulemaking. 
‘‘(B) STAKEHOLDER SUBMISSION OF PHY-
SICIAN
FOCUSED
PAYMENT
MODELS.—On an 
ongoing basis, individuals and stakeholder enti-
ties may submit to the Committee proposals for 
physician-focused payment models that such in-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00083
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
dividuals and entities believe meet the criteria 
described in subparagraph (A). 
‘‘(C) TAC 
REVIEW
OF
MODELS
SUB-
MITTED.—The Committee shall, on a periodic 
basis, review models submitted under subpara-
graph (B), prepare comments and recommenda-
tions regarding whether such models meet the 
criteria described in subparagraph (A), and 
submit such comments and recommendations to 
the Secretary. 
‘‘(D) 
SECRETARY
REVIEW
AND
RE-
SPONSE.—The Secretary shall review the com-
ments and recommendations submitted by the 
Committee under subparagraph (C) and post a 
detailed response to such comments and rec-
ommendations on the Internet Website of the 
Centers for Medicare & Medicaid Services. 
‘‘(3) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to impact the de-
velopment or testing of models under this title or ti-
tles XI, XIX, or XXI.’’. 
(2) INCENTIVE PAYMENTS FOR PARTICIPATION 
IN
ELIGIBLE
ALTERNATIVE
PAYMENT
MODELS.— 
Section 1833 of the Social Security Act (42 U.S.C. 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00084
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
1395l) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(z) INCENTIVE PAYMENTS FOR PARTICIPATION IN 
ELIGIBLE ALTERNATIVE PAYMENT MODELS.— 
‘‘(1) PAYMENT INCENTIVE.— 
‘‘(A) IN GENERAL.—In the case of covered 
professional services furnished by an eligible 
professional during a year that is in the period 
beginning with 2018 and ending with 2023 and 
for which the professional is a qualifying APM 
participant, in addition to the amount of pay-
ment that would otherwise be made for such 
covered professional services under this part for 
such year, there also shall be paid to such pro-
fessional an amount equal to 5 percent of the 
payment amount for the covered professional 
services under this part for the preceding year. 
For purposes of the previous sentence, the pay-
ment amount for the preceding year may be an 
estimation for the full preceding year based on 
a period of such preceding year that is less than 
the full year. The Secretary shall establish poli-
cies to implement this subparagraph in cases 
where payment for covered professional services 
furnished by a qualifying APM participant in 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00085
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
an alternative payment model is made to an en-
tity participating in the alternative payment 
model rather than directly to the qualifying 
APM participant. 
‘‘(B) 
FORM
OF
PAYMENT.—Payments 
under this subsection shall be made in a lump 
sum, on an annual basis, as soon as practicable. 
‘‘(C) TREATMENT
OF
PAYMENT
INCEN-
TIVE.—Payments under this subsection shall 
not be taken into account for purposes of deter-
mining actual expenditures under an alternative 
payment model and for purposes of determining 
or rebasing any benchmarks used under the al-
ternative payment model. 
‘‘(D) COORDINATION.—The amount of the 
additional payment for an item or service under 
this subsection or subsection (m) shall be deter-
mined without regard to any additional pay-
ment for the item or service under subsection 
(m) and this subsection, respectively. The 
amount of the additional payment for an item 
or service under this subsection or subsection 
(x) shall be determined without regard to any 
additional payment for the item or service 
under subsection (x) and this subsection, re-
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00086
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
spectively. The amount of the additional pay-
ment for an item or service under this sub-
section or subsection (y) shall be determined 
without regard to any additional payment for 
the item or service under subsection (y) and 
this subsection, respectively. 
‘‘(2) QUALIFYING APM PARTICIPANT.—For pur-
poses of this subsection, the term ‘qualifying APM 
participant’ means the following: 
‘‘(A) 2018 AND
2019.—With respect to 
2018 and 2019, an eligible professional for 
whom the Secretary determines that at least 25 
percent of payments under this part for covered 
professional services furnished by such profes-
sional during the most recent period for which 
data are available (which may be less than a 
year) were attributable to such services fur-
nished under this part through an entity that 
participates in an eligible alternative payment 
model with respect to such services. 
‘‘(B) 2020 AND
2021.—With respect to 
2020 and 2021, an eligible professional de-
scribed in either of the following clauses: 
‘‘(i) MEDICARE REVENUE THRESHOLD 
OPTION.—An 
eligible 
professional 
for 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00087
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
whom the Secretary determines that at 
least 50 percent of payments under this 
part for covered professional services fur-
nished by such professional during the 
most recent period for which data are 
available (which may be less than a year) 
were attributable to such services furnished 
under this part through an entity that par-
ticipates in an eligible alternative payment 
model with respect to such services. 
‘‘(ii) COMBINATION
ALL-PAYER
AND 
MEDICARE
REVENUE
THRESHOLD
OP-
TION.—An eligible professional— 
‘‘(I) for whom the Secretary de-
termines, with respect to items and 
services furnished by such professional 
during the most recent period for 
which data are available (which may 
be less than a year), that at least 50 
percent of the sum of— 
‘‘(aa) payments described in 
clause (i); and 
‘‘(bb) all other payments, re-
gardless of payer (other than 
payments made by the Secretary 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00088
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
of Defense or the Secretary of 
Veterans Affairs under chapter 
55 of title 10, United States 
Code, or title 38, United States 
Code, or any other provision of 
law, and other than payments 
made under title XIX in a State 
in which no medical home or al-
ternative payment model is avail-
able under the State program 
under that title), 
meet the requirement described in 
clause (iii)(I) with respect to pay-
ments described in item (aa) and meet 
the requirement described in clause 
(iii)(II) with respect to payments de-
scribed in item (bb); 
‘‘(II) for whom the Secretary de-
termines at least 25 percent of pay-
ments under this part for covered pro-
fessional services furnished by such 
professional during the most recent 
period for which data are available 
(which may be less than a year) were 
attributable to such services furnished 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00089
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS
HR 4015 RDS
under this part through an entity that 
participates in an eligible alternative 
payment model with respect to such 
services; and 
‘‘(III) who provides to the Sec-
retary such information as is nec-
essary for the Secretary to make a de-
termination under subclause (I), with 
respect to such professional. 
‘‘(iii) REQUIREMENT.—For purposes 
of clause (ii)(I)— 
‘‘(I) the requirement described in 
this subclause, with respect to pay-
ments described in item (aa) of such 
clause, is that such payments are 
made under an eligible alternative 
payment model; and 
‘‘(II) the requirement described 
in this subclause, with respect to pay-
ments described in item (bb) of such 
clause, is that such payments are 
made 
under 
an 
arrangement 
in 
which— 
‘‘(aa) quality measures com-
parable to measures under the 
VerDate Sep 11 2014 
23:48 Dec 17, 2014
Jkt 049200
PO 00000
Frm 00090
Fmt 6652
Sfmt 6201
E:\BILLS\H4015.RDS
H4015
emcdonald on DSK67QTVN1PROD with BILLS