I 
116TH CONGRESS 
1ST SESSION H. R. 3406 
To amend title XVIII of the Social Security Act to improve measurements 
under the skilled nursing facility value-based purchasing program under 
the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2019 
Mr. NEAL (for himself and Mr. BRADY) introduced the following bill; which 
was referred to the Committee on Ways and Means, and in addition to 
the Committee on Energy and Commerce, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to improve 
measurements under the skilled nursing facility value- 
based purchasing program under the Medicare program, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. IMPROVING MEASUREMENTS UNDER THE 
SKILLED NURSING FACILITY VALUE-BASED 
PURCHASING PROGRAM UNDER THE MEDI-
CARE PROGRAM. 
(a) IN GENERAL.—Section 1888(h) of the Social Se-
curity Act (42 U.S.C. 1395yy(h)) is amended— 
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(C) EXCLUSIONS.—With respect to pay-
ments for services furnished on or after October 
1, 2021, this subsection shall not apply to a fa-
cility for which there are not a minimum num-
ber (as determined by the Secretary) of— 
‘‘(i) cases for the measures that apply 
to the facility for the performance period 
for the applicable fiscal year; or 
‘‘(ii) measures that apply to the facil-
ity for the performance period for the ap-
plicable fiscal year.’’; 
(2) in paragraph (2)(A)— 
(A) by striking ‘‘The Secretary shall 
apply’’ and inserting ‘‘The Secretary— 
‘‘(i) shall apply’’; 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
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‘‘(ii) may, with respect to payments 
for services furnished on or after October 
1, 2022, apply additional measures deter-
mined appropriate by the Secretary, which 
may include measures of functional status, 
patient safety, care coordination, or patient 
experience. 
Subject to the succeeding sentence, in the case 
that the Secretary applies additional measures 
under clause (ii), the Secretary shall consider 
and apply, as appropriate, quality measures 
specified under section 1899B(c)(1). In no case 
may the Secretary apply more than 10 meas-
ures under this subparagraph.’’; 
(3) in subparagraph (A) of each of paragraphs 
(3) and (4), by striking ‘‘measure’’ and inserting 
‘‘measures’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(12) VALIDATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
apply to the measures applied under this sub-
section and the data submitted under sub-
section (e)(6) a process to validate such meas-
ures and data, as appropriate, which may be 
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similar to the process specified in section 
1886(b)(3)(B)(viii)(XI) for validating inpatient 
hospital measures. 
‘‘(B) FUNDING.—For purposes of carrying 
out this paragraph, the Secretary shall provide 
for the transfer, from the Federal Hospital In-
surance Trust Fund established under section 
1817, of $5,000,000 to the Centers for Medi-
care & Medicaid Services Program Management 
Account for each of fiscal years 2022 through 
2024.’’. 
(b) REPORT BY MEDPAC.—Not later than March 
15, 2021, the Medicare Payment Advisory Commission 
shall submit to Congress a report on establishing a proto-
type value-based payment program under a unified pro-
spective payment system for post-acute care services under 
the Medicare program under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.). Such report— 
(1) shall— 
(A) consider design elements such as— 
(i) measures that are important to the 
Medicare program and to beneficiaries 
under such program; 
(ii) methodologies for scoring provider 
performance and effects on payment; and 
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